Postoperative ctDNA-Guided Adjuvant Therapy in Resected Colorectal Cancer: A Systematic Review and Meta-analysis of Prognostic Validity Versus Treatment-Decision Utility.
Zheng Han, Yan Zhang, Qingjie Tian et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the prognostic validity and treatment-decision utility of postoperative circulating tumor DNA (ctDNA) in resected colorectal cancer. In seven prospective cohorts, ctDNA positivity was linked to a significantly increased recurrence risk, with a pooled hazard ratio of 7.60 (95% CI, 4.70-12.31). The findings suggest that while ctDNA is a strong marker for risk stratification, its role in guiding treatment decisions is limited.
Key findings
- Postoperative ctDNA positivity was associated with a pooled hazard ratio of 7.60 for increased recurrence risk.
- Substantial heterogeneity was observed in the analysis, with I²=80.6%.
- Evidence from DYNAMIC supports selective de-escalation in stage II colon cancer.
- Routine empiric escalation for MRD-positive disease is not supported by current evidence.
Why it matters
Understanding the role of ctDNA in postoperative settings can help clinicians better stratify patients' recurrence risks and tailor treatment approaches, although its utility in changing treatment decisions remains context-dependent.