A commentary on ‘Association between plasma circulating tumor DNA and the prognosis of esophageal cancer patients: a meta-analysis’
Year: 2024
Type: article
Abstract: Dear Editor, Esophageal cancer (EC) ranks sixth globally in terms of cancer-related deaths and is the seventh most prevalent type of cancer overall. The 5-year survival rate for resectable EC is as low as 10–30% in most countries, despite a recent rise in the disease’s survival rate1. According to a research by the International Organization for Cancer, men’s incidence and mortality rates are two to three times greater than women’s due to gender and geographical inequalities; men’s rates are greatest in Southern Africa and East Asia and lowest in Central America and West Africa2. It has been determined that circulating tumor DNA (ctDNA) is a potential biomarker for tumor diagnosis and disease monitoring. In particular, ctDNA dynamics and positivity are linked to the disease burden in a number of epithelial malignancies and have been utilized for the dynamic monitoring of gastric, colorectal, and breast cancer3. Zhang et al.4 conducted a meta-analysis to assess the correlation between ctDNA and the prognosis of EC patients. There were 13 trials involving 604 individuals. The results of the meta-analysis indicated that plasma ctDNA may be a reliable indicator of an EC patient’s overall survival as well as the progression-free and disease-free survival. For patients with locally advanced EC, surgical resection and neoadjuvant treatment (NAT) are currently the accepted protocols in numerous centers. It is unclear if surgery is truly necessary to manage locoregional illness because 23–49% of individuals exhibit a full pathologic response in the resection specimen following NAT5. Zhang et al.4 confirmed that a full pathologic response is linked to the lack of ctDNA post-NAT. Therefore, ctDNA can be used as an adjunct to restaging positron emission tomography for response evaluation. Furthermore, assessing ctDNA as part of an active monitoring regimen to check for minimum residual illness is another possible utility for patients who have received NAT and are unsuitable for surgery or decline it. The expenses linked to the required infrastructure provide a significant obstacle to the therapeutic usefulness of ctDNA. The initial outlay for assembling the labor and equipment is substantial, as is the case with any emerging technology. At present, no research has assessed how cost-effective it is to use ctDNA as a diagnostic or prognostic tool in EC. Given that EC therapy is a pricey procedure for the patient and has been projected to be more costly than other malignancies, regardless of stage, this is especially relevant to the scalability of ctDNA. Currently, few large-scale research has assessed its applicability in EC. The utility of ctDNA for monitoring and diagnosis has been validated by prospective trials with modest sample volumes. However, further progression of its clinical applications depends on making this both a cost-effective and scalable option, which depends on ensuring that its accuracy and reliability match or supersede current options. However, further progression of its clinical applications depends on making this both a cost-effective and scalable option, which depends on ensuring that its accuracy and reliability match or supersede current options. Therefore, further efforts should be made in these aspects. If the management of EC might benefit from the lessons learned from other malignancies, then ctDNA incorporation has significant potential where oncological treatment is becoming more customized. Ethical approval Ethical approval is not required because this is a comment. Consent Not applicable. Sources of funding 1. National Superior Specialty of Chinese Medicine. 2.Ningbo Natural Science Foundation (2021J305). Author contribution X.T.: writing; T.Z.: study design. Conflicts of interest disclosure The authors declares no conflicts of interest. Research registration unique identifying number (UIN) Not applicable. Guarantor Xiaolong Tu. Data availability statement A data statement is not necessary, and this is a letter. Provenance and peer review Not applicable.
Source: International Journal of Surgery
Authors: Xiaolong Tu, Tingsu Zhang
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W4401929435