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Circular RNA (circRNA)  CDR1as  is emerging as a vital tumour regulator. This study aimed to investigate its diagnostic and prognostic value and molecular mechanisms for gastric cancer (GC). CDR1as  expression in GC and adjacent normal tissues (n = 82), paired plasma (n = 65) and plasma exosome samples (n = 68) from GC patients and healthy controls were determined by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Correlations between  CDR1as  level and clinicopathological factors of GC patients were analysed. Its diagnostic and prognostic value was evaluated by receiver operating characteristic (ROC) curves and Cox regression analysis combined with Kaplan-Meier plots.  CDR1as- regulated proteins and signalling pathways were identified by quantitative proteomics and bioinformatic analysis. CDR1as  was downregulated in GC tissues and associated with tumour size and neural invasion. Plasma- and exosome-derived  CDR1as  was upregulated in GC patients while plasma-derived  CDR1as  level was related to lymphatic metastasis. Area under ROC curve (AUC) of tissue-, plasma- and exosome-derived  CDR1as  was 0.782, 0.641, 0.536 while combination of plasma  CDR1as , serum CEA and CA19-9 increased AUC to 0.786. Distal metastasis, TNM stage and tissue-derived  CDR1as  level were independent predictors for overall survival (OS) of patients. MiRNA signalling networks and glycine, serine and threonine metabolism were regulated by CDR1as and HSPE1 might be a key protein. CDR1as  is a crucial regulator and promising biomarker for GC diagnosis and prognosis.

CircRNA CDR1as : a novel diagnostic and prognostic biomarker for gastric cancer