The clinical value of minimal residual disease expression in predicting the efficacy of adjuvant therapy in patients undergoing radical resection of NSCLC

CHEN Yan; LI Peng; ZHAO Kun; YANG Yang

doi:10.3969/j.issn.1009-0460.2025.06.003

Abstract：Objective To explore the value of minimal residual disease(MRD)in predicting recurrence and adjuvant therapeutic efficacy in resectable non-small cell lung cancer(NSCLC).Methods A retrospective collection was conducted on 185 patients with stage ⅠB-ⅢA primary NSCLC who underwent radical resection at Huai'an Cancer Hospital from January 2021 to March 2024.Peripheral blood of patients was collected before the operation,2 to 4 weeks after the operation,and 3 months after the end of adjuvant therapy or 6 months after the operation.Circulating tumor DNA(ctDNA)was detected by ultra-deep targeted next-generation sequencing technology.Follow up on the recurrence of the patients and record the recurrence-free survival(RFS)time.Results There were a total of 89 cases of somatic mutations in tumor tissues,among which the preoperative positive rate of ctDNA was 67.42%(60/89).After excluding unavailable data,the positive rate of MRD after the operation was 21.43%(18/84),and the positive rate of MRD after adjuvant therapy was 12.90%(8/62).The median follow-up time was 379 days,and 36 cases relapsed.The median RFS of patients with positive ctDNA before the operation(371.00 days vs.430.00 days,P=0.019)and positive MRD after the operation(302.00 days vs.426.00 days,P<0.001)was shorter than that of the corresponding negative patients.72.22%(26/36)of the relapsed patients were detected positive for MRD at least once in the postoperative disease surveillance.The median lead time from positive MRD after surgery to imaging recurrence was 88 days.The median RFS time of patients with positive MRD detected at any monitoring time point after the operation was significantly lower than that of patients with consistently negative MRD(318.00 days vs.459.00 days,P<0.001).The results of the multivariate Cox proportional hazards regression model showed that positive postoperative MRD was an independent risk factor affecting RFS(HR=7.273-7.453,P<0.001).For patients in stage II-ⅢA with negative MRD after surgery,whether they received adjuvant therapy had no significant effect on the median RFS(405.00 days vs.369.00 days,P=0.456).For patients in stage II-ⅢA with positive MRD after surgery,the median RFS of those receiving adjuvant therapy was longer than that of those not receiving adjuvant therapy(352.00 days vs.245.00 days,P=0.011).Conclusion ctDNA is a reliable biomarker for predicting postoperative recurrence of NSCLC and the therapeutic effect after adjuvant therapy;The potential clinical value of positive MRD after surgery in guiding decisions on adjuvant therapy.