Hepato-pancreato-biliary
Shen Li, MD
Surgical Oncology Fellow
University of Chicago Medical Center
Chicago, Illinois, United States
Shen Li, MD
Surgical Oncology Fellow
University of Chicago Medical Center
Chicago, Illinois, United States
Shen Li, MD
Surgical Oncology Fellow
University of Chicago Medical Center
Chicago, Illinois, United States
Liam Spurr, MD candidate, PhD
Medical School Student
University of Chicago Medical Center, United States
Ralph Weichselbaum, MD
Professor of Radiation Oncology
University of Chicago, United States
Mitchell C. Posner, MD
Professor of Surgery
University of Chicago Medial Center, United States
Sean Pitroda, MD
Associate Professor of Radiation Oncology
University of Chicago Medical Center, United States
25-50% of patients with colorectal cancer will develop liver metastases (CRCLM). Circulating tumor DNA (ctDNA) has emerged as a prognostic biomarker in the personalized management of CRC. This single-institution retrospective study investigated the impact of ctDNA positivity on disease recurrence in patients who underwent resection for oligometastatic CRCLM.
Methods:
Patients who underwent resection of oligometastatic CRCLM with serial post-operative ctDNA assessment (SignateraTM) were investigated. Patients with extra-hepatic metastases were excluded. Univariable survival models were calculated using theĀ survivalĀ package in R v4.3.1. Log-rank P-values were calculated using a Cox proportional hazards model. For multivariable analyses, hazard ratios, 95% confidence intervals, and Wald test P-values are reported.
Results: 21 patients met eligibility for the study from 2021-2023; median patient age was 56 years (range, 34-86); 11 (52%) were men. 15 patients had synchronous disease at initial diagnosis (71%), while 6 (29%) had metachronous disease with median interval of 18 months (range, 1-48 months). 10 (48%) patients had greater than 1 liver metastasis on diagnostic imaging. Liver metastases size was greater than 5 cm in 4 patients. 6 (28%) patients received chemotherapy prior to hepatic resection while 15 patients (71%) underwent adjuvant chemotherapy. Median Clinical Risk Score (CRS) was 2 (range 0-5). ctDNA was detectable in 12 (57%) following resection, all of whom developed recurrent disease. 19 (90%) patients developed disease recurrence following liver resection at a median time of 9 months (range 1-24 months). Univariable analysis demonstrated that CRS (p=0.02) and post-operative ctDNA positivity (p=0.05) were associated with disease recurrence. On subsequent multivariable analysis, CRS (HR 1.73, 95% CI 1.06-2.847, P=0.02) and post-operative ctDNA positivity (HR 1.04, 95% CI 1.002-1.076, P=0.03) were independently associated with disease recurrence.
Conclusions:
ctDNA demonstrates promise as an independent biomarker alongside CRS to predict disease recurrence and potentially personalize therapy in patients with CRCLM. Further investigation is needed to optimize the utilization of ctDNA in patients who are candidates for resection of oligometastatic CRCLM.