From epithelial-mesenchymal transition to liquid biopsy: mechanisms of gastric cancer metastatic dissemination and circulating biomarker-guided anti-recurrence strategies
Abstract
Recurrence remains a major cause of death after curative-intent treatment of gastric cancer, and imaging may miss residual disease before macroscopic relapse. This narrative review links the biology of dissemination with circulating biomarkers and potential strategies for recurrence prevention within a gastric cancer-specific conceptual framework. We examine epithelial-mesenchymal transition and plasticity, circulating tumor cells, and pre-metastatic niche formation, with particular attention to diffuse-type tumors and peritoneal dissemination. We then assess circulating tumor DNA (ctDNA) and molecular residual disease (MRD) as indicators of tumor-derived DNA shedding and recurrence risk. These domains are biologically related but do not form an obligatory linear sequence: plasma ctDNA is not a direct measure of epithelial-mesenchymal transition or niche activity. Postoperative ctDNA positivity is associated with increased recurrence risk, whereas negative results require caution in low-shedding and isolated peritoneal disease. We distinguish established perioperative treatment benefits from MRD-guided escalation or de-escalation, for which no survival benefit has yet been shown in gastric cancer. HER2- and claudin-18.2-directed treatments are discussed in their tested disease settings and require appropriate target assessment independently of MRD status. Preclinical niche-directed approaches, including traditional Chinese medicine studies, provide hypotheses for further investigation. The framework links mechanistic and clinical research while separating prognostic validity from evidence that biomarker-guided intervention improves patient outcomes.
Related
- Epithelial-mesenchymal transition plasticity in breast cancer: regulatory mechanisms and therapeutic implications
- Mechanisms of Tumor Cell Invasion: Insights From the Perspective of Epithelial-to-Mesenchymal Transition.
- From inflammation to carcinogenesis: MiRNA regulates epithelial-mesenchymal transition to facilitate malignant progression of gastric precancerous lesions
- Isoliquiritigenin inhibits TGF-β1-induced epithelial–mesenchymal transition in pulmonary fibrosis by promoting Nix-mediated mitophagy
- UCHL1 Promotes Epithelial–Mesenchymal Transition Through E-Cadherin and N-Cadherin Switch in Endometrial Cancer
BibTeX
@article{chu2026from,
title = {{From epithelial-mesenchymal transition to liquid biopsy: mechanisms of gastric cancer metastatic dissemination and circulating biomarker-guided anti-recurrence strategies}},
author = {Tianlu Chu and Peipei Yang and Peng Shu},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1933297},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1933297},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From epithelial-mesenchymal transition to liquid biopsy: mechanisms of gastric cancer metastatic dissemination and circulating biomarker-guided anti-recurrence strategies
AU - Tianlu Chu
AU - Peipei Yang
AU - Peng Shu
PY - 2026
DA - 2026/11/09
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1933297
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1933297
AB - Recurrence remains a major cause of death after curative-intent treatment of gastric cancer, and imaging may miss residual disease before macroscopic relapse. This narrative review links the biology of dissemination with circulating biomarkers and potential strategies for recurrence prevention within a gastric cancer-specific conceptual framework. We examine epithelial-mesenchymal transition and plasticity, circulating tumor cells, and pre-metastatic niche formation, with particular attention to diffuse-type tumors and peritoneal dissemination. We then assess circulating tumor DNA (ctDNA) and molecular residual disease (MRD) as indicators of tumor-derived DNA shedding and recurrence risk. These domains are biologically related but do not form an obligatory linear sequence: plasma ctDNA is not a direct measure of epithelial-mesenchymal transition or niche activity. Postoperative ctDNA positivity is associated with increased recurrence risk, whereas negative results require caution in low-shedding and isolated peritoneal disease. We distinguish established perioperative treatment benefits from MRD-guided escalation or de-escalation, for which no survival benefit has yet been shown in gastric cancer. HER2- and claudin-18.2-directed treatments are discussed in their tested disease settings and require appropriate target assessment independently of MRD status. Preclinical niche-directed approaches, including traditional Chinese medicine studies, provide hypotheses for further investigation. The framework links mechanistic and clinical research while separating prognostic validity from evidence that biomarker-guided intervention improves patient outcomes.
SN - 2234-943X
ER -