Value and research advances of ctDNA in perioperative therapy for non-small cell lung cancer

Perioperative treatment plays an increasingly important role in improving outcomes for patients with resectable non-small cell lung cancer (NSCLC). Circulating tumor DNA (ctDNA) offers a new perspective for optimizing individualized perioperative management. This review systematically examines the core value of ctDNA in perioperative therapy for resectable NSCLC, encompassing its correlation with treatment response and pathological remission during the neoadjuvant phase, its utility as a dynamic monitor of treatment efficacy, and its emerging role in prognostic stratification and recurrence prediction in the postoperative setting. Importantly, while ctDNA demonstrates considerable promise for guiding individualized perioperative management, most applications remain investigational; we therefore distinguish between established correlative uses and prospective strategies currently under evaluation in clinical trials. It also addresses current technical challenges in ctDNA application, including limited sensitivity, false positives, lack of standardization, cost-effectiveness concerns, and difficulties in integration into clinical decision-making. Future prospective interventional studies are needed to validate ctDNA-guided treatment adjustments and to establish standardized protocols and multidisciplinary collaboration pathways, thereby facilitating the integration of ctDNA into the full course of perioperative management for NSCLC and enabling precise efficacy assessment, risk stratification, and individualized treatment decisions.