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Papel del ADN tumoral circulante preoperatorio en la predicción de metástasis ocultas en el adenocarcinoma ductal
Takeshi Murakami1, Masafumi Imamura2, Yasutoshi Kimura1
1Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo 060-0061, Hokkaidō, Japan.
World journal of gastroenterology
|September 3, 2025
Resumen
El ADN tumoral circulante preoperatorio (ctDNA) puede predecir metástasis ocultas en pacientes con adenocarcinoma ductal pancreático (PDAC). Este biomarcador indica un mal pronóstico después de la cirugía y ayuda en las decisiones de tratamiento.
Área de la Ciencia:
- En el campo de la oncología
- Diagnóstico molecular
- Oncología quirúrgica
Sus antecedentes:
- Los pacientes con adenocarcinoma ductal pancreático (PDAC) pueden tener metástasis lejanas no detectadas (metástasis ocultas, OM) que conducen a una recidiva temprana después de la cirugía.
- La predicción precisa de los OM es crucial para optimizar las estrategias de tratamiento multidisciplinario en el PDAC resecable.
Objetivo del estudio:
- Evaluar la eficacia del ADN tumoral circulante (ctDNA) como biomarcador predictivo de las metástasis ocultas en pacientes con adenocarcinoma ductal pancreático.
Principales métodos:
- Recolección prospectiva de muestras de plasma preoperatorio de 135 pacientes con PDAC en dos instituciones japonesas (julio de 2019 - septiembre de 2021).
- Análisis de ctDNA utilizando un panel de secuenciación de próxima generación que cubre 52 genes relacionados con el cáncer.
Principales resultados:
- 38 de los 135 pacientes con PDAC presentaron metástasis ocultas.
- La positividad del ctDNA fue significativamente mayor en pacientes con OM en comparación con aquellos sin OM.
- La positividad del ctDNA predijo de forma independiente los OM y se asoció con una supervivencia libre de recurrencia más corta.
Conclusiones:
- El ctDNA preoperatorio es un predictor independiente de las metástasis ocultas en el PDAC resecable.
- El ctDNA positivo indica un mal pronóstico después de la pancreatectomía.
- ctDNA puede servir como un biomarcador valioso para guiar la atención multidisciplinaria del paciente en PDAC.
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