267 DNA and RNA alterations associated with colorectal peritoneal metastases: A systematic review Future Perspectives We believe the use of comprehensive genomic profiling with for example broader cancer gene panels is essential to identify new potential cancer genes for PM prediction. In addition to using an optimal technique, we recommend applying these in a homogenous patient population (e.g. strict synchronous or metachronous PM patients, tumor characteristics, etc.). CONCLUSIONS Increasing amount of data suggest that the presence of biomarkers in the primary tumor might have an impact on metastatic patterns. However, unfortunately, based on the given evidence, we cannot consider the genes (e.g., BRAF) possibly associated with PM as reliable enough to function as an individual biomarker in a clinical setting yet. Further investigation as well as more exploratory research questions leading to identify novel biomarkers, rather than performing analyses on panels consisting mostly of already established biomarkers, are still necessary. Techniques on DNA and RNA level are required to determine an association between genomic, epigenomic and transcriptomic changes and colorectal PM. Furthermore, future studies should include homogenous populations so that firm conclusions can be drawn. In that way, we might be able to identify biomarkers that can be incorporated in a prediction tool to estimate the risk of distant metastatic spread or to create targeted treatment options. ACKNOWLEDGMENTS Gregor Franssen was involved as a professional clinical librarian to ensure an appropriate search strategy. 11
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