Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University.
Gastric Cancer Center, West China Hospital, Sichuan University, People's Republic of China; Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, People's Republic of China.
Int J Surg. 2024 Jul 1;110(7):4370-4381. doi: 10.1097/JS9.0000000000001373.
The application of liquid biopsy analysis utilizing circulating tumor DNA (ctDNA) has gained prominence as a biomarker in specific cancer types. Nevertheless, the correlation between ctDNA and the prognostic outcomes of patients with esophageal cancer (EC) remains a subject of controversy. This meta-analysis aims to assess the correlation between ctDNA and the prognosis of EC patients.
The authors systematically explored Embase, PubMed, and the Cochrane Database to identify studies reporting on the prognostic value of ctDNA in EC patients before November 2023. The primary outcome involved the determine of associations between ctDNA with overall survival (OS), disease-free survival (DFS)/recurrence-free survival (RFS), as well asprogression-free survival (PFS) among EC patients. Secondary outcomes encompassed a detailed subgroup analysis in the setting of EC, including parameters such as detection time, histological subtypes, treatment modalities, regions, anatomic locations, and detection methods. Publication bias was assessed utilizing Begg's test, Egger's test, and funnel plots. A sensitivity analysis was conducted by systematically excluding individual studies to evaluate the stability of the results.
A total of 1203 studies were initially screened, from which 13 studies underwent further analysis, encompassing 604 patients diagnosed with EC. The comprehensive pooled analysis indicated a significant association between the detection of ctDNA and poor OS (HR: 3.65; 95% CI: 1.97-6.75, P <0.001), DFS/RFS (HR: 6.08; 95% CI: 1.21-30.50, P <0.001), and PFS (HR: 2.84; 95% CI: 1.94-4.16, P <0.001). Subgroup analysis showed that ctDNA remained a consistent negative predictor of OS when stratified by different detection time, histological subtypes, regions, anatomic locations, and detection methods. Furthermore, subgroup analysis stratified by regions and study types demonstrated an association between ctDNA detection and poor PFS in EC patients.
Our results indicate plasma ctDNA may serve as robust prognostic markers for OS, DFS/RFS, and PFS among EC patients. This finding suggests that plasma ctDNA could offer a highly effective approach for risk stratification and personalized medicine.
利用循环肿瘤 DNA（ctDNA）进行液体活检分析已成为特定癌症类型的生物标志物。然而，ctDNA 与食管癌（EC）患者预后之间的相关性仍然存在争议。本荟萃分析旨在评估 ctDNA 与 EC 患者预后之间的相关性。
作者系统地检索了 Embase、PubMed 和 Cochrane 数据库，以确定截至 2023 年 11 月报告 ctDNA 对 EC 患者预后价值的研究。主要结局包括确定 ctDNA 与 EC 患者的总生存期（OS）、无病生存期（DFS）/无复发生存期（RFS）以及无进展生存期（PFS）之间的相关性。次要结局包括在 EC 背景下进行详细的亚组分析，包括检测时间、组织学亚型、治疗方式、区域、解剖部位和检测方法等参数。采用 Begg 检验、Egger 检验和漏斗图评估发表偏倚。通过系统排除个别研究来进行敏感性分析，以评估结果的稳定性。
共筛选出 1203 项研究，其中 13 项研究进一步分析，共纳入 604 例确诊为 EC 的患者。综合荟萃分析表明，ctDNA 的检测与较差的 OS（HR：3.65；95%CI：1.97-6.75，P <0.001）、DFS/RFS（HR：6.08；95%CI：1.21-30.50，P <0.001）和 PFS（HR：2.84；95%CI：1.94-4.16，P <0.001）之间存在显著相关性。亚组分析显示，当按不同的检测时间、组织学亚型、区域、解剖部位和检测方法进行分层时，ctDNA 仍然是 OS 的一致负预测因子。此外，按区域和研究类型进行的亚组分析表明，ctDNA 检测与 EC 患者的不良 PFS 之间存在相关性。
我们的结果表明，血浆 ctDNA 可能是 EC 患者 OS、DFS/RFS 和 PFS 的强有力的预后标志物。这一发现表明，血浆 ctDNA 可能为风险分层和个体化医疗提供一种非常有效的方法。
