Role of preoperative circulating tumor DNA in predicting occult metastases in resectable and borderline resectable pancreatic ductal adenocarcinoma

Figure 1 Patient enrollment and sample collection. R: Resectable; BR: Borderline resectable; PDAC: Pancreatic ductal adenocarcinoma; NAT: Neoadjuvant therapy; pCR: Pathologiccaly complete response; pTis: Pathological carcinoma in situ.

Figure 2 Association between circulating tumor DNA status and prognosis. A: Kaplan-Meier curve of postoperative recurrence-free survival (RFS) in circulating tumor DNA (ctDNA)-positive and -negative groups of 125 patients who underwent pancreatectomy, excluding 10 patients who underwent laparotomy. During the observation period of 37.1 months, the median RFS in the ctDNA-positive group was 10.2 months, significantly worse than the 258 months in the ctDNA-negative group (P = 0.023); B: Kaplan-Meier curve of postoperative overall survival in ctDNA-positive and -negative groups of 135 patients. The median overall survival in the ctDNA-positive group was 22.9 months, significantly worse than the 411 months in the ctDNA-negative group (P = 0.039). ctDNA: Circulating tumor DNA.

Figure 3 Kaplan-Meier curves of circulating tumor DNA dynamics and postoperative recurrence-free survival in 31 patients sampled before and after neoadjuvant therapy. The median recurrence-free survival (RFS) of 20.2 months for the group whose circulating tumor DNA (ctDNA) changed from positive to negative after neoadjuvant therapy (NAT) was not significantly different from the median RFS of 18 months for the group whose ctDNA remained negative during NAT (P = 0.862). ctDNA: Circulating tumor DNA; RFS: Recurrence-free survival.