Liquid biopsy after resection of pancreatic adenocarcinoma and its relation to oncological outcomes. Systematic review and meta-analysis

Laura Vidal; Elizabeth Pando; Laia Blanco; Carles Fabregat-Franco; Florian Castet; Alexandre Sierra; Teresa Macarulla; Joaquim Balsells; Ramón Charco; Ana Vivancos

doi:10.1016/j.ctrv.2023.102604

Liquid biopsy after resection of pancreatic adenocarcinoma and its relation to oncological outcomes. Systematic review and meta-analysis

Cancer Treat Rev. 2023 Nov:120:102604. doi: 10.1016/j.ctrv.2023.102604. Epub 2023 Aug 6.

Authors

Affiliations

¹ Department of HPB and Transplant Surgery, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
² Department of HPB and Transplant Surgery, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: elizabeth.pando@vallhebron.cat.
³ Department of HPB and Transplant Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
⁴ Gastrointestinal and Endocrine Tumour Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁵ Cancer Genomics Lab, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.

PMID: 37572593
DOI: 10.1016/j.ctrv.2023.102604

Abstract

Background: It has been hypothesised that manipulation during surgery releases tumoral components into circulation. We investigate the effect of surgery on plasma-borne DNA biomarkers and the oncological outcomes in resectable pancreatic ductal adenocarcinoma (PDAC). We also compare non-touch isolation techniques (NTIT) with standard techniques.

Materials and methods: We performed a systematic review and a meta-analysis of studies analysing liquid biopsy as circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), and messenger RNA (mRNA) in resectable PDAC patients who underwent surgery and its association with overall survival (OS) and disease-free survival (DFS). Research in EMBASE, Web of Science and PubMed was performed. The ctDNA shift negative-to-positive (ctDNA -/+) or ctDNA shift positive-to-negative (ctDNA +/-) before and after surgery was evaluated.

Results: Twelve studies comprising 413 patients were included. Shorter OS and DFS were identified in patients with positive ctDNA status before (HR = 2.28, p = 0.005 and HR = 2.16, p = 0.006) or after surgery (HR = 3.88, p < 0.0001 and HR = 3.81, p = 0.03), respectively. Surgical resection increased the rate of ctDNA +/-. There were no differences in OS or DFS in the ctDNA +/- group compared with ctDNA +/+ or ctDNA -/+. However, there was a trend to shorter OS in the ctDNA -/+ group (HR = 5.00, p = 0.09). No differences between NTIT and standard techniques on liquid biopsy status were found.

Conclusion: Positive ctDNA in the perioperative period is associated with a worse prognosis. Surgical resection has a role in the negativisation of liquid biopsy status. More studies are needed to assess the potential of minimally invasive techniques on ctDNA dynamics.

Keywords: Liquid biopsy; Meta-analysis; Non-touch isolation technique; Pancreatic surgery; Resectable pancreatic adenocarcinoma; ctDNA.

Publication types

Review