Circulating tumor DNA and recurrence after curative-intent treatment of hepatocellular carcinoma: A systematic review and meta-analysis.
Salah A Abdelrahim, Reem M Gahtani, Sameer Alqassimi et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis examined whether circulating tumor DNA (ctDNA) detection predicts outcomes after curative-intent treatment for hepatocellular carcinoma. It included 12 cohort studies involving 880 patients. Preoperative ctDNA detection was associated with worse recurrence-free survival (RFS; HR 3.34, 95% CI 1.99-5.63), while postoperative detection was associated with worse RFS (HR 4.95, 95% CI 2.77-8.83) and overall survival (OS; HR 3.07, 95% CI 1.80-5.23). Certainty was moderate for the preoperative RFS association and low for postoperative outcomes.
Key findings
- Preoperative ctDNA detection was associated with worse RFS (HR 3.34, 95% CI 1.99-5.63; 4 studies, 291 patients; moderate certainty).
- Postoperative ctDNA detection was associated with worse RFS (HR 4.95, 95% CI 2.77-8.83; 11 studies, 799 patients; low certainty; I 2 = 79%).
- Postoperative ctDNA detection was associated with worse OS (HR 3.07, 95% CI 1.80-5.23; 3 studies, 357 patients; low certainty).
- Diagnostic accuracy for subsequent recurrence was modest (8 studies, 508 patients; very-low certainty).
Why it matters
The findings suggest ctDNA detection may help identify patients at higher risk of recurrence or death after curative-intent HCC treatment. However, the evidence varies across studies, and the modest diagnostic accuracy and low certainty for postoperative outcomes limit confidence in its use for individual risk assessment.
What to keep in mind
The evidence came from cohort studies and had heterogeneity, small-study effects, and risk-of-bias concerns. Studies were insufficiently comparable for assay-platform or sampling-time analyses, and prospective validation is needed.