Progress in application of peritoneal lavage fluid circulating tumor DNA to predicting peritoneal metastasis of gastrointestinal cancer

Abstract

Peritoneal metastasis is one of the important causes of death in patients with gastrointestinal cancer and is also a difficult point in clinical diagnosis and treatment. How to predict the occurrence of peritoneal metastasis in patients with high-risk factors, advance the threshold of diagnosis and treatment before the occurrence of peritoneal metastasis, and improve the survival benefit of patients is an unsolved problem in clinical work. In the case of low positive rate of cytology and difficulty in diagnosing occult peritoneal metastasis, new molecular markers and detection techniques for early diagnosis of peritoneal metastasis need to be verified. Peritoneal lavage fluid has the characteristics of less leukocyte-derived cell-free DNA interference, higher concentration of circulating tumor DNA (ctDNA), and direct contact with the primary lesion or potential peritoneal metastasis at physical distance, making it a unique advantage in gastrointestinal cancer. At present, the detection methods of ctDNA in peritoneal lavage fluid include digital PCR, epigenetic-based analysis, and next-generation sequencing. With the iteration of technology, the application of next-generation sequencing and personalized panels to ctDNA detection has not only shown great potential in predicting postoperative peritoneal metastasis, but also promoted the idea of preventive escalation treatment of peritoneal metastasis. This article reviews the current application of ctDNA to peritoneal lavage fluid in predicting peritoneal metastasis of gastrointestinal cancer.

Keywords

• gastrointestinal cancer
• peritoneal metastasis
• peritoneal lavage fluid
• circulating tumor dna