ctDNA and Prognosis and Recurrence of Gastric Cancer/ Gastroesophageal Adenocarcinoma: A Meta-Analysis

Objective:The aim of this study was to evaluate whether circulating tumor DNA (ctDNA) levels predict the prognosis and recurrence of gastric cancer and/or gastroesophageal adenocarcinoma by meta-analysis using existing literature.Method:A systematic search of databases such as PubMed, EMBASE, Cochrane Library and manual collection of literature related to ctDNA and prognosis and recurrence events in gastric cancer and/or gastroesophageal adenocarcinoma. The studies that met the inclusion criteria were classified, and literature quality evaluation was drawn by RevMan 5.4 software, and forest plots and funnel plots were drawn by Stata software to evaluate the predictive power of ctDNA for complete remission, disease progression, death, and disease recurrence in patients with gastric cancer/gastroesophageal adenocarcinoma.Results:This study included 16 articles on the ctDNA of gastric cancer and gastroesophageal adenocarcinoma. Statistical analysis shows that ctDNA testing has some sensitivity and good specificity for judging efficacy (complete response); however, the power to predict disease progression and death is limited; ctDNA can be used as a potential biomarker to predict recurrence of gastroesophageal adenocarcinoma. Among patients with gastroesophageal adenocarcinoma, ctDNA is superior to those with gastric cancer alone in predicting death. The risk assessment of literature bias suggested that the inclusion of inter-study bias was not related to reported effects, and the risk of bias in this study was small.Conclusion:This study confirmed the potential value of ctDNA in monitoring treatment response and prognosis of gastroesophageal carcinoma. ctDNA can be used as a sensitive biomarker to judge efficacy and predict tumor recurrence, but its power in predicting disease progression and death remains to be verified. ctDNA detection in esophageal carcinoma may be superior to that in gastric cancer. There was a low risk of bias between studies included. ctDNA shows the application prospects as a new biomarker for precision medicine of gastric cancer/gastroesophageal adenocarcinoma.