Correlation of tumor-naive methylation-based preoperative ctDNA testing with pathologic upstaging and occult metastasis in early-stage solid tumors.

作者：Xiangnan Li, Jiandong Tai, Jiaqi Liu, Shuai Wang, Xianjun Yu, Danbo Wang, Lixin Sun, Ziqiang Tian, Songbing He, Huaiwu Lu, Xiang Guo, Hao Wen, Yan Zhang, Desong Yang, Zhuowei Liu, Guolin Ye, Si Shi, Yang Wang, Yueqi Li, X. Wu · 发表于：Journal of Clinical Oncology · 年份：2026 · DOI：10.1200/jco.2026.44.16_suppl.1616 · 研究领域：Cancer Genomics and Diagnostics、Epigenetics and DNA Methylation、Esophageal Cancer Research and Treatment

1616 Background: The TNM staging system serves as the cornerstone for most solid tumor treatment strategies. However, preoperative evaluation of early-stage cancers is not always reliable, with a particular propensity to overlook occult lymph node metastasis (OLNM) or even distant metastases. In turn, incorrect staging may lead to suboptimal perioperative decisions, including inappropriate surgical strategies, unjustified neoadjuvant therapy, and inadequate lymph node dissection. This study evaluated whether preoperative circulating tumor DNA (ctDNA) detected by methylation-based assay is associated with pathologic upstaging and the presence of OLNM or distant metastasis across multiple types of solid tumor. Methods: This study analyzed preoperative blood samples from a validation cohort within a multi-cancer early detection (MCED) study, encompassing 16 high-burden cancer types in China. Lymphomas, liver cancer, and nasopharyngeal carcinoma were excluded, due to limited use of TNM staging and/or non-routine radical surgery. Patients who had received neoadjuvant therapy were also excluded. ctDNA was detected using a targeted methylation-based MCED assay. Associations between ctDNA positivity and discrepancies between clinical (cTNM) and pathologic (pTNM) staging-including upstaging due to OLNM or distant metastasis-were examined statistically. Results: A total of 681 cases of clinical stage I–II cancers were analyzed, including lung cancer (n=124), breast cancer (n=113), colo...