Published online Jul 15, 2018. doi: 10.4251/wjgo.v10.i7.145
Peer-review started: March 8, 2018
First decision: March 19, 2018
Revised: April 22, 2018
Accepted: June 8, 2018
Article in press: June 9, 2018
Published online: July 15, 2018
Colorectal cancer (CRC) treatment has become more personalised, incorporating a combination of the individual patient risk assessment, gene testing, and chemotherapy with surgery for optimal care. The improvement of staging with high-resolution imaging has allowed more selective treatments, optimising survival outcomes. The next step is to identify biomarkers that can inform clinicians of expected prognosis and offer the most beneficial treatment, while reducing unnecessary morbidity for the patient. The search for biomarkers in CRC has been of significant interest, with questions remaining on their impact and applicability. The study of biomarkers can be broadly divided into metabolic, molecular, microRNA, epithelial-to-mesenchymal-transition (EMT), and imaging classes. Although numerous molecules have claimed to impact prognosis and treatment, their clinical application has been limited. Furthermore, routine testing of prognostic markers with no demonstrable influence on response to treatment is a questionable practice, as it increases cost and can adversely affect expectations of treatment. In this review we focus on recent developments and emerging biomarkers with potential utility for clinical translation in CRC. We examine and critically appraise novel imaging and molecular-based approaches; evaluate the promising array of microRNAs, analyze metabolic profiles, and highlight key findings for biomarker potential in the EMT pathway.
Core tip: Biomarkers are an emerging field that can potentially guide the diagnosis, prognosis, and treatment course in rectal cancer. Here, the current definitions, classifications, recent developments and emerging biomarkers with potential utility for clinical translation in colorectal cancer are reviewed by international experts for a better understanding in surgery.