The prognostic significance of circulating tumor DNA in prostate cancer: A systematic review and meta-analysis.

Abstract

214 Background: Circulating tumor DNA (ctDNA) has attracted increasing interest as a biomarker in multiple cancers. This study aimed to perform a systematic review and meta-analysis to evaluate the prognostic value of ctDNA in prostate cancer (PCa). Methods: An electronic search of PubMed, Embase, and the Cochrane library was conducted to identify eligible studies. Hazard ratios (HRs) and corresponding 95% confidence intervals (95%CIs) for progression-free survival (PFS) and overall survival (OS) were extracted for pooled analysis. Data were pooled using a fixed-effects or random-effects models based on the study heterogeneity. Subgroup analyses were performed according to disease status, study design, treatment regimen, and sequencing method. R software (version 4.2.2) was used for statistical analysis. Results: A total of 13 studies comprising 1946 patients with PCa were included. The pooled analysis showed that higher baseline ctDNA levels were associated with shorter PFS (HR 2.88, 95%CI 1.98-4.19, P<0.001) and OS (HR 2.57, 95%CI 1.66-3.97, P<0.001) in overall PCa patients. Subgroup analysis further indicated that the prognostic value of ctDNA levels remained consistent across different study designs, systemic treatment regimens, and sequencing methods. Additionally, elevated ctDNA levels were significantly correlated with shorter PFS (HR 2.56, 95%CI 1.69-3.87, P<0.001) and OS (HR 2.76, 95%CI 1.76-4.33, P<0.001) in the metastatic castration-resistant prostate cancer (mCRPC) setting. Conclusions: Our systematic review and meta-analysis demonstrated that higher ctDNA levels were associated with poorer survival outcomes in patients with PCa, suggesting that ctDNA may serve as a valuable prognostic biomarker in PCa.