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Circulating tumor DNA as a biomarker for progression and survival in esophageal cancer after neoadjuvant therapy and esophagectomy: a systematic review and meta-analysis

  • 0Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
International Journal of Surgery (london, England) +

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August 12, 2025

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August 12, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Circulating tumor DNA (ctDNA) after neoadjuvant therapy and surgery predicts worse survival and lower pathologic complete response (pCR) in esophageal cancer (EC) patients. Standardizing ctDNA detection is crucial for clinical use.

Area Of Science

  • Oncology
  • Molecular Diagnostics
  • Cancer Biomarkers

Background

  • Circulating tumor DNA (ctDNA) is a promising biomarker for cancer treatment monitoring and outcome prediction.
  • Esophageal cancer (EC) patients undergoing neoadjuvant therapy (NAT) can benefit from prognostic biomarkers.
  • Evaluating ctDNA's prognostic value in EC post-NAT is critical for treatment planning.

Purpose Of The Study

  • To assess the prognostic significance of ctDNA for survival outcomes and pathologic complete response (pCR) in EC patients receiving NAT.
  • To determine if baseline or post-treatment ctDNA levels predict treatment efficacy.
  • To provide evidence for ctDNA's role in risk stratification for EC patients.

Main Methods

  • Systematic literature search of PubMed, Web of Science, and Embase (August-September 2024).
  • Inclusion of observational studies and randomized clinical trials reporting ctDNA associations with progression-free survival (PFS), overall survival (OS), or pCR.
  • Meta-analysis using fixed-effects models to pool hazard ratios (HRs) and odds ratios (ORs), with heterogeneity and bias assessments.

Main Results

  • Baseline ctDNA detection showed no significant association with PFS, OS, or pCR.
  • Post-NAT ctDNA detection significantly correlated with worse PFS (HR 3.81) and OS (HR 3.00), and lower pCR rates (OR 0.26).
  • Post-surgery ctDNA detection also predicted worse PFS (HR 4.17) and OS (HR 4.00).

Conclusions

  • Post-NAT and post-surgery ctDNA detection are strong predictors of adverse survival outcomes and reduced pCR in EC.
  • ctDNA shows potential as a biomarker for risk stratification and personalized treatment strategies in EC.
  • Standardization of ctDNA detection methods is necessary to enhance its clinical applicability.

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