The field of cancer surgery needs new biomarkers. With all the advances in medical technology that have occurred since I was performing McBurney incisions as an intern 33 years ago, surgeons have not evolved in how we screen and follow up with most patients with solid tumors. Guo et al1 have described in this issue of JAMA Surgery what is to my knowledge the first study examining the long noncoding RNA (lncRNA) gastric cancer–associated lncRNA 1 (GClnc1) as a biomarker in circulating exosomes for gastric cancer. This represents a complete analysis in a relatively small cohort of patients, demonstrating promise as a screening assay, a prognostic tool, and a follow-up test. They measured a sensitivity and specificity of 87.2% and 87.1%, respectively, in patients with early gastric cancer vs healthy donors, which was significantly better and independent of known protein biomarkers (carcinoembryonic antigen, cancer antigen [CA] 72-4, and CA19-9). They demonstrated a correlation with the stage of the tumor and a drop after surgical resection and perhaps during successful chemotherapy (although data were not shown for this outcome).
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Bartlett DL. Better Biomarkers for Surgeons Treating Cancer. JAMA Surg. Published online June 10, 2020. doi:10.1001/jamasurg.2020.1134
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