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Meta-Analysis
. 2023 Sep;12(17):17934-17944.
doi: 10.1002/cam4.6434. Epub 2023 Aug 8.

Treatment stratification and prognosis assessment using circulating tumor DNA in locally advanced rectal cancer: A systematic review and meta-analysis

Junjie Mi  1 , Rong Wang  1 , Xiaofang Han  2 , Ruijun Ma  1 , Danyu Zhao  1
Affiliations
Meta-Analysis

Treatment stratification and prognosis assessment using circulating tumor DNA in locally advanced rectal cancer: A systematic review and meta-analysis

Junjie Mi et al. Cancer Med. 2023 Sep.

Abstract

Background: Circulating tumor DNA (ctDNA) is an emerging biomarker for locally advanced rectal cancer (LARC), giving hope for stratified treatment. As the completed studies have small sample sizes and different experimental methods, systematic review and meta-analysis were performed to explore their role in predicting pathological complete response (pCR), tumor recurrence, and prognosis.

Methods: PubMed, Embase, and the Web of Science were searched for potentially eligible studies published up to September 6, 2022. Pooled relative risk (RR) was calculated to predict pCR and tumor recurrence, and pooled hazard ratio (HR) was calculated to evaluate the prognosis of overall survival (OS), recurrence-free survival (RFS), and metastasis-free survival (MRS).

Results: Twelve studies published between 2018 and 2022 included 931 patients, and 2544 serum samples were eventually included in the meta-analysis. The pooled revealed that ctDNA-negative patients were more likely to have a pCR (RR = 1.64, 95% confidence interval [CI]: 1.26-2.12). The pooled revealed that ctDNA-positive patients were at high risk of recurrence (RR = 3.37, 95% CI: 2.34-4.85) and had a poorer prognosis for OS (HR = 3.03, 95% CI: 1.86-4.95), RFS (HR = 7.08, 95% CI: 4.12-12.14), and MRS (HR = 2.77, 95% CI: 2.01-3.83).

Conclusion: ctDNA may be useful for stratifying treatment and assessing prognosis in patients with LARC, but its clinical application still needs to be confirmed in a prospective multicenter study with large samples.

Keywords: circulating tumor DNA; locally advanced rectal cancer; pathological complete response; prognosis; recurrence.

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Conflict of interest statement

There are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot of pooled effect for relative risk in circulating tumor DNA prediction of pathological complete response.
FIGURE 2
FIGURE 2
Forest plot of pooled effect for relative risk in circulating tumor DNA prediction of locally advanced rectal cancer recurrence.
FIGURE 3
FIGURE 3
Forest plot on circulating tumor DNA prediction of overall survival with a pooled effect hazard ratio.
FIGURE 4
FIGURE 4
Forest plot on circulating tumor DNA prediction of progression‐free survival with a pooled effect hazard ratio.
See this image and copyright information in PMC

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