소화기계 암에서의 순환종양세포 분석과 임상적 가치 = Utility and Clinical Value of Circulating Tumor Cells in Gastrointestinal Cancer

국문 초록 (Abstract)

소화기계 암은 전체 암 발병률의 26%를 차지하는 매우흔한 암이며, 암 관련 사망률의 35%를 차지해 다른 암종에 비해 사망률이 높다[1]. 이러한 소화기계 암 환자의 대부분은 암 전이로 인해 사망하며, 특히 폐와 간, 뼈로의 전이가 흔하게 발생한다[2]. 국소암에 비해 원격 전이가 발생한 암의 경우 치료 선택의 폭이 크게 좁아지기 때문에,전이 암세포의 특징을 잘 이해하고 이에 맞는 약물을 선정하는 것은 소화기계 암 환자의 생존율을 높이는데 매우중요하다.
이런 원격 전이의 주요 인자로 잘 알려져 있는 것이 바로 순환종양세포(circulating tumor cell, CTC)이다.
CTC는 고형 종양에서 유래하여 epithelial–mesenchymaltransition 과정을 거쳐 순환계로 들어온 암 세포를 말한다. CTC는 일반적인 암 세포에 비해 줄기세포성이 크지만 증식 능력은 다소 감소된 경향을 보인다[3]. 대부분의 CTC는 원발암에서 떨어진 직후부터 주변세포 외 기질과의 상호작용 상실로 일어나는 세포 사멸인 anoikis, 혈류의 전단 응력, 면역세포의 공격으로 인해 대부분 사멸하고, 오직 극소수의 CTC만이 생존하여mesenchymal-epithelial transition 과정 속에서 전이가 일어난다고 알려져 있다[4].
따라서 환자의 혈액에서 발견되는 CTC는 전이 가능성과 연관되며, CTC의 수를 통해 환자의 예후를 평가할 수있으며 유전분석을 통해 원발암의 유전 변이에 대한 정보를 획득할 수 있다. 본 고에서는 CTC의 소화기계 암에서의 임상적 활용에 대해 논의하고자 한다.

다국어 초록 (Multilingual Abstract)

Circulating tumor cells (CTCs) are a valuable biomarker for the diagnosis, prognosis, and therapeuticmanagement of gastrointestinal (GI) cancers. A major challenge in GI cancer treatmentis the high rate of metastasis, which significantly contributes to cancer-related mortality. CTCsare crucial in the metastatic cascade, serving as indicators of tumor progression. Therefore, thedetection and molecular characterization of CTCs have prognostic potential for identifyingearly-stage GI cancers and assessing metastatic probability, enabling timely treatment. Moreover,CTC analysis offers a minimally invasive method for real-time monitoring of tumors.
Clinicians can adjust therapeutic strategies accordingly by tracking changes in CTC count andmolecular profile. Despite this promising application, no standardized protocol for CTC isolationin GI tract cancers has been established, which poses a barrier to routine clinical use. Thisreview explores the current CTC detection methodologies, their clinical relevance in GI cancermanagement, and the potential integration of CTC analysis into personalized medicine. Wealso discuss the challenges and future directions in CTC research, focusing on clinical validationand the development of standardized procedures to fully realize the utility of CTC countfor improving patient care.

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