Undetectable pre-radical cystectomy circulating tumour DNA status predicts improved oncological outcomes

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2024-10-16 DOI:10.1111/bju.16556

Reuben Ben-David, Sarah Lidagoster, Jack Geduldig, Kaushik P. Kolanukuduru, Yuval Elkun, Neeraja Tillu, Asher Mandel, Mohammed Almoflihi, Basil Kaufmann, Kyrollis Attalla, Reza Mehrazin, Peter Wiklund, John P. Sfakianos

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引用次数: 0

Abstract

Objective

To assess recurrence-free survival (RFS) in patients with undetectable tumour-informed circulating tumour DNA (ctDNA) before radical cystectomy (RC) and evaluate if those who converted from detectable to undetectable ctDNA status after RC have similar RFS outcomes as those with persistently undetectable ctDNA status.

Patients and Methods

Patients who underwent RC had prospectively and longitudinally collected tumour-informed ctDNA analyses during 2021–2023. ctDNA status was informed from the pre-RC specimen. The minimal residual disease (MRD) window was defined as the initial 90 days after RC. RFS was evaluated using the Kaplan–Meier method. Cox regression analysis was performed to find predictors of disease recurrence.

Results

The cohort included 135 patients with 647 ctDNA analyses. The median (interquartile range [IQR]) age was 71 (63–77) years. Over a median (IQR) follow-up of 11 (7–18) months, 41 patients (30%) had a recurrence. Pre-RC undetectable ctDNA status was found in 54 patients (40%). The RFS rates at 6, 12, and 21 months were 98%, 93%, and 82%, respectively. Of 77 patients with undetectable ctDNA status at the MRD window available for conversion dynamics analysis, 43 had persistently undetectable ctDNA status (both at pre-RC and MRD window) and 31 converted from pre-RC detectable to MRD undetectable status (conversion group). The persistently undetectable group had significantly better RFS than the conversion group (log-rank, P < 0.001), with 12-month RFS rates of 97% vs 51%, and 18-month RFS rates of 88% vs 51%, respectively. On Cox multivariate analysis, only the conversion group status predicted disease recurrence.

Conclusions

Patients with undetectable pre-RC ctDNA status have a favourable prognosis and may be candidates for treatment de-escalation. Those with persistently undetectable ctDNA had superior RFS compared to the conversion group. Pre-RC ctDNA status should be incorporated into trials examining ctDNA use in clinical decision-making.

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根治性膀胱切除术前检测不到循环肿瘤 DNA 状态可预示肿瘤治疗效果的改善

目的：评估根治性膀胱切除术（RC）前检测不到肿瘤信息循环肿瘤DNA（ctDNA）的患者的无复发生存期（RFS），并评估RC后从检测到ctDNA转为检测不到的患者是否与持续检测不到ctDNA的患者具有相似的RFS结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.