Bola Sumrit, Cutts Anthony, Vavoulis Dimitris, Shrivastava Manu, Bhuva Shaheel, Schuh Anna, Shah Ketan, Winter Stuart C, Taylor Jenny C
Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Department of Oncology, University of Oxford, Oxford, UK.
Eur J Cancer. 2025 Sep 9;227:115626. doi: 10.1016/j.ejca.2025.115626. Epub 2025 Jul 10.
PET-CT and MRI are used to assess disease response after head and neck cancer treatment. Equivocal findings can delay the potential for salvage curative treatment or result in over- treatment with further surgery. The aims of this study were to establish if liquid biopsy (LB) of circulating tumour DNA, could be used to aid decision-making after treatment.
Patients (n = 41) undergoing chemoradiotherapy (CRT) and surgical treatment had serial blood testing; pre-treatment and 10-12 weeks post-treatment, alongside imaging. PET-CT/MRIs were categorised as Cancer, Equivocal or Complete Response and true disease status was determined retrospectively. A bespoke 17-gene panel and probes targeting 5 HPV subtypes were used for next-generation sequencing in the ctDNA assay.
PET-CT was equivocal in 13/27 CRT patients; sensitivity and specificity for determining true disease status was 67 % and 42 % respectively. LB performed better at determining true disease status than PET-CT post-treatment in CRT patients; sensitivity and specificity of 83 % and 95 % respectively. A combined LB/PET/MRI test performed better than imaging alone; sensitivity and specificity of 100 % and 90 % respectively. The improved specificity was statistically significant (Fisher's exact test OR=7.1; 95 % CI:1.6-45.8, p = 0.0005), as was the balanced accuracy (Welch's t-test, p < 0.0001).
LB outperformed PET-CT at determining true disease status after CRT and could complement post-treatment imaging in CRT and surgical patients, playing a potential role in decision-making after treatment.
正电子发射断层扫描-计算机断层扫描（PET-CT）和磁共振成像（MRI）用于评估头颈癌治疗后的疾病反应。模棱两可的结果可能会延迟挽救性根治性治疗的可能性，或导致进一步手术的过度治疗。本研究的目的是确定循环肿瘤DNA的液体活检（LB）是否可用于辅助治疗后的决策。
接受放化疗（CRT）和手术治疗的患者（n = 41）进行了系列血液检测；治疗前和治疗后10 - 12周，同时进行影像学检查。PET-CT/MRI被分类为癌症、模棱两可或完全缓解，并回顾性确定真实疾病状态。在ctDNA检测中，使用定制的17基因面板和针对5种人乳头瘤病毒（HPV）亚型的探针进行下一代测序。
13/27例CRT患者的PET-CT结果模棱两可；确定真实疾病状态的敏感性和特异性分别为67%和42%。在确定CRT患者治疗后的真实疾病状态方面，LB比PET-CT表现更好；敏感性和特异性分别为83%和95%。联合LB/PET/MRI检测比单独影像学检查表现更好；敏感性和特异性分别为100%和90%。提高的特异性具有统计学意义（Fisher精确检验OR = 7.1；95%可信区间：1.6 - 45.8，p = 0.0005），平衡准确性也具有统计学意义（Welch t检验，p < 0.0001）。
在确定CRT后的真实疾病状态方面，LB优于PET-CT，并且可以补充CRT和手术患者的治疗后影像学检查，在治疗后的决策中发挥潜在作用。
