O'Donnell Conor D J, Naleid Nikolas, Siripoon Teerada, Zablonski Kevin G, Storandt Michael H, Selfridge Jennifer E, Hallemeier Christopher L, Conces Madison L, Jethwa Krishan R, Bajor David L, Thiels Cornelius A, Warner Susanne G, Starlinger Patrick P, Atwell Thomas D, Mitchell Jessica L, Mahipal Amit, Jin Zhaohui
Mayo Clinic School of Graduate Education, Mayo Clinic College of Medicine, Mayo Building, Rochester, MN 55905, USA.
Department of Medicine, University Hospitals of Cleveland, Lakeside Building, 11100 Euclid Avenue, Cleveland, OH 44016, USA.
Cancers (Basel). 2024 Jun 29;16(13):2407. doi: 10.3390/cancers16132407.
(1) Background: Local therapies offer a potentially curative approach for patients with oligometastatic colorectal cancer (CRC). An evidence-based consensus recommendation for systemic therapy following definitive locoregional therapy is lacking. Tumor-informed circulating tumor DNA (ctDNA) might provide information to help guide management in this setting. (2) Methods: A multi-institutional retrospective study was conducted, including patients with CRC that underwent curative-intent locoregional therapy to an isolated site of metastatic disease, followed by tumor-informed ctDNA assessment. The Kaplan-Meier method and log-rank tests were used to compare disease-free survival based on ctDNA results. ctDNA test performance was compared to carcinoembryonic antigen (CEA) test results using McNemar's test. (3) Results: Our study cohort consisted of 87 patients treated with locoregional interventions who underwent ctDNA testing. The initial ctDNA test post-intervention was positive in 28 patients and negative in 59 patients. The median follow-up time was 14.0 months. Detectable ctDNA post-intervention was significantly associated with early disease recurrence, with a median disease-free survival (DFS) of 6.63 months compared to 21.30 months in ctDNA-negative patients ( < 0.001). ctDNA detected a numerically higher proportion of recurrences than CEA ( < 0.097). Post-intervention systemic therapy was not associated with improved DFS ( = 0.745). (4) Conclusions: ctDNA results are prognostically important in oligometastatic CRC, and further prospective studies are urgently needed to define its role in guiding clinical decisions.
(1) 背景：局部治疗为寡转移结直肠癌（CRC）患者提供了一种潜在的治愈方法。对于确定性局部区域治疗后的全身治疗，缺乏基于证据的共识性推荐。肿瘤信息性循环肿瘤DNA（ctDNA）可能提供信息以帮助指导这种情况下的管理。(2) 方法：进行了一项多机构回顾性研究，纳入接受了针对孤立转移病灶的根治性局部区域治疗，随后进行肿瘤信息性ctDNA评估的CRC患者。采用Kaplan-Meier法和对数秩检验基于ctDNA结果比较无病生存期。使用McNemar检验将ctDNA检测性能与癌胚抗原（CEA）检测结果进行比较。(3) 结果：我们的研究队列由87例接受局部区域干预并进行ctDNA检测的患者组成。干预后首次ctDNA检测中，28例患者呈阳性，59例患者呈阴性。中位随访时间为14.0个月。干预后可检测到ctDNA与早期疾病复发显著相关，ctDNA阳性患者的无病生存期（DFS）中位数为6个月，而ctDNA阴性患者为21.30个月（P<0.001）。ctDNA检测到的复发比例在数值上高于CEA（P<0.097）。干预后全身治疗与DFS改善无关（P=0.745）。(4) 结论：ctDNA结果在寡转移CRC中具有预后重要性，迫切需要进一步的前瞻性研究来确定其在指导临床决策中的作用。
