Cancers
Circulating Tumor DNA in Resected Colorectal Liver Metastases: From Minimal Residual Disease Detection to Treatment Guidance—A Systematic Review
By Melina Yerolatsite, Nanteznta Torounidou, Loizos Hadjigeorgiou and 5 others.
Abstract
Background
Circulating tumor DNA (ctDNA) has emerged as a potential marker of minimal residual disease (MRD) after resection of colorectal liver metastases (CRLM), but its prognostic value and possible role in guiding postoperative management remain uncertain. This systematic review evaluated the available evidence on ctDNA for predicting recurrence and survival after CRLM resection, with particular attention to perioperative and serial ctDNA measurements and their potential value in guiding adjuvant treatment.
Methods
PubMed/MEDLINE, Scopus, and the Cochrane Library were searched from inception to 21 July 2026 for studies evaluating ctDNA in patients undergoing resection of CRLM. Prospective and retrospective cohort studies and relevant randomized trial sub-studies were eligible. The primary outcome was the association between ctDNA status and recurrence, while secondary outcomes included recurrence-free survival (RFS), disease-free survival (DFS), overall survival (OS), serial ctDNA dynamics, and the potential predictive value of ctDNA for adjuvant chemotherapy. Risk of bias was assessed using the QUIPS tool. Findings were synthesized narratively, with an additional exploratory random-effects meta-analysis of early postoperative tissue-informed ctDNA positivity and RFS/DFS. Unadjusted and adjusted HRs were pooled separately.