Wang Bolin, Zou Bing, Xu Shengnan, Zhao Chao, Pei Jinli, Wang Shijie, Zhao Kunlong, Yu Jinming, Liu Jie
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Front Oncol. 2023 Jan 20;13:1083417. doi: 10.3389/fonc.2023.1083417. eCollection 2023.
To date, identifying resectable stage I non-small cell lung cancer (NSCLC) patients likely to benefit from adjuvant therapy (ADT) remains a major challenge. Previous studies suggest that circulating tumor DNA (ctDNA) is emerging as a promising biomarker for NSCLC. However, the effectiveness of ctDNA detection in guiding ADT for resectable stage I NSCLC patients remains elusive. This study aimed to elucidate the role of ctDNA detection in estimating prognosis and guiding ADT for resectable stage I NSCLC patients.
Individual patient data and ctDNA results data were collected from 270 patients across four independent cohorts. The detection of ctDNA was conducted at 3 days to 1 month after surgery. The endpoint for this study was relapse-free survival (RFS) and overall survival (OS).
Of the 270 resectable stage I NSCLC patients, 9 patients with ctDNA-positive and 261 patients with ctDNA-negative. We found that the risk of recurrence was significantly lower in the ctDNA-negative group compared to the ctDNA-positive group(HR=0.11, p<0.0001). However, there is no difference in the risk of death between the two groups (p =0.39). In the ctDNA-positive group, there were no significant differences in RFS between patients who received ADT and patients who did not receive ADT (p =0.58). In the ctDNA-negative group, those who received ADT had a worse RFS in comparison with those who did not receive ADT (HR=2.36, p =0.029). No difference in OS was seen between patients who received ADT and patients who did not receive ADT in both the ctDNA-positive group and the ctDNA-negative group (All p values>0.05). Furthermore, there was no difference in RFS and OS between patients who received chemotherapy-based or tyrosine kinase inhibitor-based ADT and patients who did not receive ADT in both the ctDNA-positive group and the ctDNA-negative group (All p values>0.05).
Postoperative ctDNA detection can be a prognostic marker to predict recurrence but has limited effects in guiding ADT for resectable stage I NSCLC. Future prospective investigations are needed to verify these results.
迄今为止，识别可能从辅助治疗（ADT）中获益的可切除的Ⅰ期非小细胞肺癌（NSCLC）患者仍然是一项重大挑战。既往研究表明，循环肿瘤DNA（ctDNA）正成为NSCLC一种有前景的生物标志物。然而，ctDNA检测在指导可切除的Ⅰ期NSCLC患者进行ADT方面的有效性仍不明确。本研究旨在阐明ctDNA检测在评估可切除的Ⅰ期NSCLC患者预后及指导ADT中的作用。
收集来自4个独立队列的270例患者的个体患者数据和ctDNA检测结果数据。ctDNA检测在术后3天至1个月进行。本研究的终点为无复发生存期（RFS）和总生存期（OS）。
在270例可切除的Ⅰ期NSCLC患者中，9例ctDNA阳性，261例ctDNA阴性。我们发现，ctDNA阴性组的复发风险显著低于ctDNA阳性组（HR=0.11，p<0.0001）。然而，两组之间的死亡风险无差异（p=0.39）。在ctDNA阳性组中，接受ADT的患者与未接受ADT的患者的RFS无显著差异（p=0.58）。在ctDNA阴性组中，接受ADT的患者与未接受ADT的患者相比，RFS更差（HR=2.36，p=0.029）。在ctDNA阳性组和ctDNA阴性组中，接受ADT的患者与未接受ADT的患者的OS均无差异（所有p值>0.05）。此外，在ctDNA阳性组和ctDNA阴性组中，接受基于化疗或酪氨酸激酶抑制剂的ADT的患者与未接受ADT的患者的RFS和OS均无差异（所有p值>0.05）。
术后ctDNA检测可作为预测复发的预后标志物，但在指导可切除的Ⅰ期NSCLC患者进行ADT方面作用有限。未来需要前瞻性研究来验证这些结果。
