PDF(Pubmed)
Abstract：
(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 (p < 0.001). ctDNA detected a numerically higher proportion of recurrences than CEA (p < 0.097). Post-intervention systemic therapy was not associated with improved DFS (p = 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.
摘要：
（1）背景：局部治疗为寡转移性结直肠癌（CRC）患者提供了潜在的治愈方法。缺乏在确定性局部治疗后进行全身治疗的循证共识建议。肿瘤知情的循环肿瘤DNA（ctDNA）可能会提供信息，以帮助指导在这种情况下的管理。(2)方法:采用多机构回顾性研究,包括对转移性疾病的孤立部位进行治愈性局部治疗的CRC患者，其次是肿瘤知情的ctDNA评估。使用Kaplan-Meier方法和对数秩检验来比较基于ctDNA结果的无病存活率。ctDNA测试性能与使用McNemar测试的癌胚抗原（CEA）测试结果进行比较。（3）结果：我们的研究队列包括87例接受局部区域干预治疗的患者，这些患者接受了ctDNA测试。干预后的初始ctDNA测试在28例患者中为阳性，在59例患者中为阴性。中位随访时间为14.0个月。可检测的ctDNA干预后与早期疾病复发显著相关，ctDNA阴性患者的中位无病生存期（DFS）为6.63个月，而非21.30个月（p<0.001）。ctDNA检测到的复发比例高于CEA（p<0.097）。干预后的全身治疗与改善的DFS无关（p=0.745）。（4）结论：ctDNA结果在寡转移CRC中具有重要的预后意义。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。
