期刊
ANNALS OF SURGICAL ONCOLOGY
卷 27, 期 9, 页码 3259-3267出版社
SPRINGER
DOI: 10.1245/s10434-020-08331-x
关键词
Cancer prognostication; Liquid biopsy; Cancer surveillance
资金
- NCATS NIH HHS [TL1 TR001443] Funding Source: Medline
- NCI NIH HHS [CA023100, P30 CA023100] Funding Source: Medline
- NIH HHS [TL1TR001443] Funding Source: Medline
Background Circulating tumor DNA (ctDNA) is a promising technology for treatment selection, prognostication, and surveillance after definitive therapy. Its use in the perioperative setting for patients with metastatic disease has not been well studied. We characterize perioperative plasma ctDNA and its association with progression-free survival (PFS) in patients undergoing surgery for peritoneal metastases. Patients and Methods We recruited 71 patients undergoing surgery for peritoneal metastases and evaluated their plasma with a targeted 73-gene ctDNA next-generation sequencing test before and after surgery. The association between perioperative ctDNA, as well as other patient factors, and PFS was evaluated by Cox regression. Results ctDNA was detectable in 28 patients (39.4%) preoperatively and in 37 patients (52.1%) postoperatively. Patients with high ctDNA [maximum somatic variant allele fraction (MSVAF) > 0.25%] had worse PFS than those with low MSVAF (< 0.25%) in both the pre- and postoperative settings (median 4.8 vs. 19.3 months,p < 0.001, and 9.2 vs.15.0 months,p = 0.049, respectively; log-rank test). On multivariate analysis, high-grade histology [hazard ratio (HR) 3.42,p = 0.001], incomplete resection (HR 2.35,p = 0.010), and high preoperative MSVAF (HR 3.04,p = 0.001) were associated with worse PFS. Patients with new postoperative alterations in the context of preoperative alteration(s) also had a significantly shorter PFS compared with other groups (HR 4.28,p < 0.001). Conclusions High levels of perioperative ctDNA and new postoperative ctDNA alterations in the context of preoperative alterations predict worse outcomes in patients undergoing resection for peritoneal metastases. This may highlight a role for longitudinal ctDNA surveillance in this population.
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