Abstract：
Systemic treatment of resectable non-small cell lung cancer (NSCLC) is evolving with emerging neoadjuvant, perioperative, and adjuvant immunotherapy approaches. Circulating tumor DNA (ctDNA) detection at clinical diagnosis, during neoadjuvant therapy, or after resection may discern high-risk patients who might benefit from therapy escalation or switch. This Review summarizes translational implications of data supporting ctDNA-based risk determination in NSCLC and outstanding questions regarding ctDNA validity/utility as a prognostic biomarker. We discuss emerging ctDNA capabilities to refine clinical tumor-node-metastasis (TNM) staging in lung adenocarcinoma, ctDNA dynamics during neoadjuvant therapy for identifying patients deriving suboptimal benefit, and postoperative molecular residual disease (MRD) detection to escalate systemic therapy. Considering differential relapse characteristics in landmark MRD-negative/MRD-positive patients, we propose how ctDNA might integrate with pathological response data for optimal postoperative risk stratification.
摘要：
可切除的非小细胞肺癌（NSCLC）的系统治疗正在随着新辅助治疗的发展而发展。围手术期,和辅助免疫疗法。循环肿瘤DNA（ctDNA）检测在临床诊断，在新辅助治疗期间，或切除后可能会发现可能从治疗升级或转换中受益的高危患者。这篇综述总结了支持NSCLC中基于ctDNA的风险确定的数据的翻译意义，以及关于ctDNA有效性/实用性作为预后生物标志物的突出问题。我们讨论了新兴的ctDNA能力，以完善肺腺癌的临床肿瘤淋巴结转移（TNM）分期，新辅助治疗期间的ctDNA动力学，用于识别获得次优益处的患者，和术后分子残留病（MRD）检测以逐步升级全身治疗。考虑到具有里程碑意义的MRD阴性/MRD阳性患者的差异复发特征，我们提出了ctDNA如何与病理反应数据相结合，以实现最佳的术后风险分层。
