Every year roughly 150,000 Americans are diagnosed with Colorectal Cancer. More concerning rate of younger Americans under 55 diagnosed with Colorectal Cancer is increasing by 1-2% annually. Of those 25% already have a metastasis and 50% will develop a metastasis after diagnosis or treatment.
I recently presented this paper at the Central Surgical Association Meeting and was just accepted in SURGERY.
𝐀𝐁𝐒𝐓𝐑𝐀𝐂𝐓
𝐎𝐛𝐣𝐞𝐜𝐭𝐢𝐯𝐞: In this pilot study, we sought to determine if preoperative circulating tumor DNA (ctDNA) could be a useful predictor to avoid futile metastasectomy, predict early postoperative recurrence, and determine optimal chemotherapy duration during the management of patients with resectable metastatic colorectal cancer(mCRC).
𝐌𝐞𝐭𝐡𝐨𝐝𝐬: Patients from 2021-2023 were enrolled prospectively and evaluated with ctDNA preoperatively and postoperatively for detection of recurrence. Clinicopathologic and treatment factors as well as disease-free survival were compared between those with undetectable vs. detectable preoperative ctDNA.
𝐑𝐞𝐬𝐮𝐥𝐭𝐬: Twenty-eight patients evaluated with a median follow-up time of 24 months. The median preoperative ctDNA level was 0.16MTM/ml[0.00,2.30]. Of the 10 patients(40%) with a preoperative ctDNA level of zero, 5(50%) of patients recurred between 4 and 18 months postoperatively. Among the 18 patients who recurred, 10(56%) patients had ctDNA detected postoperatively. Median change between preoperative to postoperative ctDNA levels was 0.00[-0.02,0.05] in those who did not recur and 0.00[-7.04,0.00] in those who recurred. When disease-free survival(DFS) was evaluated by detectable vs undetectable preoperative ctDNA levels, there was no difference in DFS estimates(p value=0.11). On univariate Cox-proportional hazards analysis, the preoperative ctDNA level, change between preoperative and postoperative ctDNA levels, and postoperative ctDNA levels did not influence DFS. However, those with detectable postoperative ctDNA were 3.96[95%CI 1.30-12.06] times as likely to recur compared to those with undetectable postoperative ctDNA.
𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧: New technologies including use of ctDNA may help better predict which patients with colorectal liver metastases will undergo futile surgery. Our preliminary findings suggest that postoperative, and not preoperative, ctDNA is predictive of recurrence following metastasectomy. Utilization of ctDNA in guiding operative management should be done in conjunction with high quality imaging and other serologic markers to determine which patients with colorectal liver metastases are likely to receive durable benefit from operative intervention.
Comments