无症状与有症状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.
发表日期：2024 Oct 10
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
来源：
BRITISH JOURNAL OF CANCER
摘要：
多项举措旨在开发循环肿瘤 DNA (ctDNA) 检测，用于无症状个体的早期癌症检测。少数描述无症状和有症状患者 ctDNA 检测的研究报告称，无症状患者的 ctDNA 检出率较低。在这里，我们探讨无症状患者是否与有症状患者不同。通过纳入“低 ctDNA 脱落”和“攻击性较小”亚组。在连续招募的无症状结直肠癌 (CRC) 患者的两个独立队列中进行了 ctDNA 评估（队列#1：n = 215，队列#2： n = 368）和有症状的 CRC（队列#1：n = 117，队列#2：n = 722）。调整肿瘤分期和大小后，与有症状患者相比，无症状患者的 ctDNA 检测几率显着较低（队列#2：n = 722）。 #1：OR：0.4，95%CI：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，与有症状患者相比，ctDNA 阴性无症状患者的复发风险最低（队列#1：sHR：0.2，95%CI：0.1-0.6，队列#2：sHR：0.3，95%CI：0.2-0.6）我们的研究表明，无症状患者富含“低 ctDNA 脱落、低复发风险”亚组。需要此类见解来指导基于 ctDNA 的早期检测计划，并应促进有关 ctDNA 阴性无症状 CRC 患者的治疗降级和随访的讨论。© 2024。作者。
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.© 2024. The Author(s).