566P - A systematic review and meta-analysis of the prognostic value of total cell-free DNA quantification in metastatic colorectal cancer

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Colon and Rectal Cancer
Presenter Karen-Lise Spindler
Citation Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370
Authors K.G. Spindler1, A.K. Boysen1, N. Palisgaard2, J. Johansen3, J. Tabernero4, P.M. Mau-Soerensen5, T.F. Hansen6, D. Sefrioui7, B.V. Jensen3, B.S. Soerensen8, R.F. Andersen9, C. Demuth8, I. Brandslund9, A. Jakobsen6
  • 1Oncology, Aarhus University Hospital, 8000 - Aarhus/DK
  • 2Pathology, Roskilde Hospital, Roskilde/DK
  • 3Department Of Oncology, Herlev Hospital, Copenhagen University Hospital, Copenhagen/DK
  • 4Universitat Autònoma De Barcelona, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), 08035 - Barcelona/ES
  • 5Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen/DK
  • 6Oncology, Danish Colorectal Cancer Center South, 7100 - Vejle/DK
  • 7Department Of Of Hepato-gastroenterology, IRON (equipe de recherche onco normande) within INSERM unit U1079., Rouen/FR
  • 8Clinical Biochemistry, Aarhus University Hospital, Aarhus C/DK
  • 9Clinical Biochemistry, Danish Colorectal Cancer Center South, 7100 - Vejle/DK



Circulating DNA is a mixture of DNA from normal and tumor cells.The majority of studies analyses the clinical potential of tumor specific mutations which are detectable in a fraction of patients. In contrast, the total cell-free DNA (cfDNA) can be analyzed in all patients and a normal upper limit provided for standardization. Studies suggest that levels of total cfDNA are higher in CRC than healthy controls and associated with a poor prognosis in metastatic disease. This indicates a strong clinical potential calling for statistical validation. The aim was to perform a systematic review and meta-analysis of the prognostic value of total cfDNA in patients with metastatic colorectal cancer (mCRC) treated with chemotherapy.


A systematic literature search of PubMed and Embase was performed by two independent investigators (KGS and AKB). Eligibility criteria were; total cfDNA analysis, mCRC, prognostic value during palliative treatment. The PRISMA guidelines were followed, and meta-analysis applied on both aggregate data extraction and individual patients' data provided by the authors when applicable. Primary endpoint was overall survival (OS).


A total of 11 patient cohorts were identified, including a total of 1158 patients. The majority of data were based on patients with late-line disease, but also a cohort of 86 patients in second-line, and study in the first-line settings, with similar results. Seven studies used qPCR methods, two BEAMing technology and two digital droplet PCR. The baseline median levels of cfDNA was similar in the presented studies, and all individual studies reported a clear prognostic value in favor of patients with lowest levels of baseline cfDNA. The meta-analysis revealed a combined estimate of favorable overall survival hazard ratio (HR) in patients with levels below the median cfDNA (HR = 2.46, 95% CI 2.17-2.75, p 


The total cfDNA levels are high in patients with mCRC and bear strong prognostic information, which should be tested prospectively by using a pre-defined cut-off value. Total cfDNA can be measured in a simple pre-treatment blood sample and potentially aid in clinical decision-making.

Clinical trial identification

Legal entity responsible for the study



Novo Nordisk Foundation


All authors have declared no conflicts of interest.