Molecular subtyping and precision therapy for esophageal cancer

Abstract Esophageal cancer (EC) is a prevalent malignancy of the digestive tract with high rates of morbidity and mortality. Two main types of EC, Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), differ significantly in their molecular characteristics and response to treatment. Current clinical management primarily involves surgery and chemoradiotherapy; however, the limited efficacy and severe side effects of traditional treatments have led to unsatisfactory outcomes. Recent advancements in molecular classification and precision therapy offer new strategies for improving EC treatment. This article reviews the progress in the molecular classification of EC and its application in precision therapy, providing a theoretical basis and practical guidance for clinical management. We emphasize how multiple omics, such as genomics, transcriptomics and proteomics, enhance our understanding of the molecular characteristics of EC. Additionally, we analyze current clinical research and the effectiveness of targeted therapies and immunotherapies. We found that significant progress has been made in the molecular classification of EC, and studies have revealed the impact of multiple key gene mutations and signaling pathways (e.g., TP53, PIK3CA, EGFR) across different subtypes. Although targeted therapy and immunotherapy have shown good clinical efficacy, challenges such as high heterogeneity and drug resistance persist in current precision therapy. Future research should focus on overcoming drug resistance, finding new biomarkers, and optimizing treatment strategies.