Oxidative Stress Biomarkers in Oncology: Biological Mechanisms, Clinical Utility, and Organizational Considerations

Abstract

Oxidative stress is a fundamental driver of carcinogenesis and tumor progression, arising from an imbalance between reactive oxygen or nitrogen species and antioxidant defense mechanisms. This redox disruption contributes to genomic instability, metabolic reprogramming, inflammation, immune modulation, and therapy resistance processes that together influence the biological behavior of cancer. A broad spectrum of oxidative stress biomarkers has been evaluated in oncology, including markers of lipid peroxidation, protein oxidation, DNA oxidation, and enzymatic or non-enzymatic antioxidant systems. This review integrates current mechanistic knowledge of the formation and functional significance of these biomarkers and evaluates clinical evidence regarding their diagnostic, prognostic, and predictive usefulness across multiple cancer types. We examine whether oxidative stress biomarkers could complement established measures of risk and describe treatment-related changes in systemic oxidative status, while distinguishing these potential applications from validated clinical uses. Despite promising findings, biomarker implementation remains limited by analytical variability, lack of standardized reference ranges, and insufficient prospective validation. Beyond biomedical considerations, the review also highlights key organizational and quality-related factors that may influence the integration of oxidative stress biomarkers into clinical practice. These include laboratory quality assurance requirements, methodological standardization, workflow and data management needs, and broader health system implications. By integrating mechanistic, clinical, analytical, and organizational evidence, this review identifies the validation and quality requirements that must be met before oxidative stress biomarkers can inform routine oncology decisions.