Prognostic value of circulating tumor DNA in pancreatic cancer: a systematic review and meta-analysis

Abstract

Increasing evidence has revealed the potential correlation between circulating tumor DNA (ctDNA) and the prognosis of pancreatic cancer, but inconsistent findings have been reported. Therefore, a meta-analysis was performed to evaluate the prognostic value of ctDNA in pancreatic cancer. The Embase, MEDLINE, and Web of Science databases were searched for relevant articles published until April 2020. Articles reporting the correlation between ctDNA and the prognosis of pancreatic cancer were identified through database searches. The pooled hazard ratios (HRs) for prognostic data were calculated and analyzed using Stata software. A total of 2326 patients pooled from 25 eligible studies were included in the meta-analysis to evaluate the prognostic value of ctDNA in pancreatic cancer. Patients with mutations detected or high concentrations of ctDNA had a significantly poorer overall survival (OS) (univariate: HR = 2.54; 95% CI, 2.05-3.14; multivariate: HR = 2.07; 95% CI, 1.69-2.54) and progression-free survival (PFS) (univariate: HR = 2.18; 95% CI, 1.41-3.37; multivariate: HR = 2.20; 95% CI, 1.38-3.52). In conclusion, the present meta-analysis indicates that mutations detected or high concentrations of ctDNA are significant predictors of OS and PFS in patients with pancreatic cancer.

Monitoring of circulating tumour DNA in advanced pancreatic ductal adenocarcinoma predicts clinical outcome and reveals disease progression earlier than radiological imaging

“…We demonstrated an independent prognostic value of baseline ctDNA detection in our study, an observation that confirms previously published results, including several meta-analyses [13,14]. Our HRs of 2.1 and 2.0 for PFS and OS, respectively, were slightly lower than in our previously published pilot study and the pooled data analyses [11].…”

“…ctDNA is DNA that is released from apoptotic and necrotic tumour cells into the bloodstream [ 10 ]. Several studies, including multiple meta‐analyses, support the prognostic potential of ctDNA detection in plasma, demonstrating that patients in whom ctDNA is detected have a significantly worse prognosis than those in whom it is not detected [ 11 , 12 , 13 , 14 , 15 , 16 ]. Some studies have also explored the relationship between ctDNA and imaging, showing associations between the dynamics of ctDNA and the radiological response [ 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Circulating Tumor DNA Detection by Digital-Droplet PCR in Pancreatic Ductal Adenocarcinoma: A Systematic Review

“…ctDNA is a valued diagnostic PDAC tool. Moreover, ctDNA is believed to play an important role in PDAC prognosis [80]. KRAS ctDNA MAF has been associated with PDAC clinical stage [81].…”

Analysis of Risk Factors for Distant Metastasis of Pancreatic Ductal Adenocarcinoma without Regional Lymph Node Metastasis and a Nomogram Prediction Model for Survival

“…Ueberroth al. [ 21 ] and Yin et al [ 22 ] found that circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) could be detected in the blood of N 0 pancreatic cancer patients who achieved pathological complete remission after radical resection of pancreatic cancer or neoadjuvant therapy, which suggests a poor prognosis and a high risk of distant metastasis [ 23 ]. Similarly, our study found that among the 4491 PDAC with N 0 and distant metastasis patients, 1538 (34.24%) also had distant metastasis, which means that the risk of recurrence and metastasis in N 0 patients may have been previously underestimated.…”