Circulating tumor DNA for predicting recurrence in patients with operable breast cancer: a systematic review and meta-analysis

作者：Guilherme Nader Marta, Marta Monteforte, Elisa Agostinetto, Michela Cinquini, Diogo Alexandre Martins-Branco, Mireille Langouo Fontsa, Antonio Llombart‐Cussac, Javier Cortés, Michail Ignatiadis, Valter Torri, Giovanni Apolone, Vera Cappelletti, Giancarlo Pruneri, Evandro de Azambuja, Serena Di Cosimo · 发表于：ESMO Open · 年份：2024 · DOI：10.1016/j.esmoop.2024.102390 · 被引用次数：75 · 研究领域：Cancer Genomics and Diagnostics、Cancer Cells and Metastasis、Breast Cancer Treatment Studies

BACKGROUND: The incorporation of circulating tumor DNA (ctDNA) into the management of operable breast cancer (BC) has been hampered by the heterogeneous results from different studies. We aimed to assess the prognostic value of ctDNA in patients with operable (non metastatic) BC. MATERIALS AND METHODS: A systematic search of databases (PubMed/Medline, Embase, and CENTRAL) and conference proceedings was conducted to identify studies reporting the association of ctDNA detection with disease-free survival (DFS) and overall survival (OS) in patients with stage I-III BC. Log-hazard ratios (HRs) were pooled at each timepoint of ctDNA assessment (baseline, after neoadjuvant therapy, and follow-up). ctDNA assays were classified as primary tumor-informed and non tumor-informed. RESULTS: Of the 3174 records identified, 57 studies including 5779 patients were eligible. In univariate analyses, ctDNA detection was associated with worse DFS at baseline [HR 2.98, 95% confidence interval (CI) 1.92-4.63], after neoadjuvant therapy (HR 7.69, 95% CI 4.83-12.24), and during follow-up (HR 14.04, 95% CI 7.55-26.11). Similarly, ctDNA detection at all timepoints was associated with worse OS (at baseline: HR 2.76, 95% CI 1.60-4.77; after neoadjuvant therapy: HR 2.72, 95% CI 1.44-5.14; and during follow-up: HR 9.19, 95% CI 3.26-25.90). Similar DFS and OS results were observed in multivariate analyses. Pooled HRs were numerically higher when ctDNA was detected at the end of neoadjuvant therapy or durin...