Gastric cancer (GC) is the fourth most-commonly diagnosed cancer, and the third leading cause of cancer-associated mortality worldwide.
1 Despite improvements in treatment modalities, the prognosis for advanced GC following curative resection remains poor.
2 By contrast, patients diagnosed with early-stage GC have a favorable prognosis, underscoring the paradigm that identification at earlier stages remains an attractive strategy for reducing GC-associated patient mortality. Although endoscopic surveillance accompanied by pathological examination of tissue biopsies remains the criterion standard for screening and diagnosis of patients with asymptomatic GC, this approach is inadequate for screening the average-risk population because of its invasive nature and high expense. Thus, the use of liquid biopsy-based, noninvasive cancer biomarkers has become increasingly desirable, and several promising molecular biomarkers have been identified in blood, urine, and gastric juice.
3-5 Despite these advances, serum levels of carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) are the only markers currently available for clinical use. However, these biomarkers are typically not elevated in early-stage GCs and are therefore inadequate at identifying patients with early-stage GC.