ESMO Congress 2023 | OncologyPRO

Abstract 2405P

Background

At present, the prognostic stratification of urothelial carcinoma(UC) patients heavily relies on tumor staging, which is limited by the quality of the tissue samples assessed. Recently, circulating tumor DNA(ctDNA) has shown potential as a molecular tool for the diagnosis, staging, and prognosis of UC. We aimed to conduct a systematic review and meta-analysis to evaluate the prognostic value of ctDNA in patients with UC.

Methods

The MEDLINE, EMBASE, and the Cochrane Library databases were searched from the inception to March 2023 to identify studies investigating the relationship between detection of ctDNA and clinical outcomes in patients with UC. Hazard ratios (HRs) of disease-free survival (DFS) and overall survival (OS) were extracted and meta-analysis was performed using the R software (version 4.2.1).

Results

Twelve studies with 1844 patients were ultimately included in this meta-analysis. Ten studies assessed the relationship between baseline ctDNA detection and patient outcomes. Patients with an elevated ctDNA level exhibited significantly worse DFS (HR=6.22; 95% CI, 3.78-10.25, p<0.001) and OS (HR=4.09; 95% CI, 3.02-7.96, p<0.001). Similar results were observed in subgroup analyses in patients with muscle-invasive UC and metastatic UC, respectively. Four studies evaluated the prognostic value of ctDNA dynamics during treatment or observation. Patients who exhibited a decrease or clearance in ctDNA levels demonstrated a more favorable DFS (HR=0.31, 95% CI, 0.16–0.59, p=0.0003) and OS (HR=0.24, 95% CI, 0.14–0.43,P<0.001) compared to those who did not.

Conclusions

Our meta-analysis demonstrated a robust correlation between levels of plasma ctDNA at baseline/during treatment and oncologic outcomes in patients with UC. These findings indicate that plasma ctDNA offers substantial clinical utility in the risk stratification and personalized prognosis of patients.