无症状与有症状的结直肠癌患者的循环肿瘤DNA和复发风险
Circulating tumour DNA and risk of recurrence in patients with asymptomatic versus symptomatic colorectal cancer
影响因子:6.80000
分区:医学2区 Top / 肿瘤学2区
发表日期:2024 Nov
作者:
Nadia Øgaard, Sarah Østrup Jensen, Mai-Britt Worm Ørntoft, Christina Demuth, Mads Heilskov Rasmussen, Tenna Vesterman Henriksen, Jesper Nors, Amanda Frydendahl, Iben Lyskjær, Marijana Nesic, Christina Therkildsen, Jakob Kleif, Mikail Gögenur, Lars Nannestad Jørgensen, Jesper Vilandt, Jakob Benedict Seidelin, Kåre Anderson Gotschalck, Claudia Jaensch, Berit Andersen, Uffe Schou Løve, Ole Thorlacius-Ussing, Per Vadgaard Andersen, Thomas Kolbro, Alessio Monti, Jeppe Kildsig, Peter Bondeven, Nis Hallundbæk Schlesinger, Lene Hjerrild Iversen, Morten Rasmussen, Ismail Gögenur, Jesper Bertram Bramsen, Claus Lindbjerg Andersen
摘要
多种倡议旨在开发无症状个体早期癌症检测的循环肿瘤DNA（CTDNA）测试。少数描述无症状和有症状患者CTDNA测试的研究报告了无症状患者的CTDNA检测较低。在这里，我们探讨了无症状患者是否与有症状的患者不同，例如通过在两次独立招募的无症状结直肠癌（CRC）（CRC）（队列＃1：n = 215，队列＃2：n = 368）和症状CRC（症状CRC（COMANTOMANT CRC（COMANTOMANT CRC））中，在两种独立招募的被招募的无症状结直肠癌（CRC）的患者中进行了两种独立招募的患者，进行了两种独立招募的患者，进行了两种独立招募的患者，并进行了两种独立的招募患者，并进行了两种独立的同类，并进行了＃1：N = 117，对于肿瘤阶段和大小，与有症状的患者相比，无症状患者的CTDNA检测的几率显着降低（OR：0.4，95％CI：0.2-0.8：0.2-0.8，队列＃2：OR：0.7，95％CI：0.5-0.9）。此外，无症状患者的复发风险较低（队列＃1：SHR：0.6，95％CI：0.3-1.2，队列＃2：SHR：0.6，95％CI：0.4-1.0）。值得注意的是，与有症状的患者相比，ctDNA阴性的无症状患者的复发风险最低（队列＃1：SHR：0.2，95％CI：0.1-0.6：0.1-0.6，同伴2：SHR：0.3，95％CI：0.2-0.6）。需要进行此类见解来指导基于CTDNA的早期检测计划，并应促使讨论有关降低治疗的降级和CTDNA阴性无症状CRC患者的随访。
Abstract
Multiple initiatives aim to develop circulating tumour DNA (ctDNA) tests for early cancer detection in asymptomatic individuals. The few studies describing ctDNA-testing in both asymptomatic and symptomatic patients report lower ctDNA detection in the asymptomatic patients. Here, we explore if asymptomatic patients differ from symptomatic patients e.g. by including a 'low-ctDNA-shedding' and 'less-aggressive' subgroup.ctDNA assessment was performed in two independent cohorts of consecutively recruited patients with asymptomatic colorectal cancer (CRC) (Cohort#1: n = 215, Cohort#2: n = 368) and symptomatic CRC (Cohort#1: n = 117, Cohort#2: n = 722).After adjusting for tumour stage and size, the odds of ctDNA detection was significantly lower in asymptomatic patients compared to symptomatic patients (Cohort#1: OR: 0.4, 95%CI: 0.2-0.8, Cohort#2: OR: 0.7, 95%CI: 0.5-0.9). Further, the recurrence risk was lower in asymptomatic patients (Cohort#1: sHR: 0.6, 95%CI: 0.3-1.2, Cohort#2: sHR: 0.6, 95%CI: 0.4-1.0). Notably, ctDNA-negative asymptomatic patients had the lowest recurrence risk compared to the symptomatic patients (Cohort#1: sHR: 0.2, 95%CI: 0.1-0.6, Cohort#2: sHR: 0.3, 95%CI: 0.2-0.6).Our study suggests that asymptomatic patients are enriched for a 'low-ctDNA-shedding-low-recurrence-risk' subgroup. Such insights are needed to guide ctDNA-based early-detection initiatives and should prompt discussions about de-escalation of therapy and follow-up for ctDNA-negative asymptomatic CRC patients.