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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 120942
Published online Aug 15, 2026. doi: 10.4251/wjgo.120942
Quantitative TP53 circulating tumor DNA predicts tumor response and survival outcomes in esophageal squamous cell carcinoma
Xin Li, Xiao-Wei Wang, Hai Jin, Zhi-Sheng Piao, Tao Liu, Ren-Tong Gu
Ren-Tong Gu, Department of Thoracic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China
Tao Liu, Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
Zhi-Sheng Piao, Department of Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China
Hai Jin, Xiao-Wei Wang, Xin Li, Department of Thoracic Surgery, Changhai Hospital, Shanghai 200433, China
Co-first authors: Ren-Tong Gu and Tao Liu.
Co-corresponding authors: Xiao-Wei Wang and Xin Li.
Author contributions: Gu RT, Liu T, Wang XW, and Li X conceptualized the study; Gu RT and Liu T prepared the original draft, they contributed equally to this article, they are the co-first authors of this manuscript; Gu RT, Liu T, and Piao ZS conducted the investigation and formal analysis; Piao ZS curated the data; Wang XW, and Li X developed the methodology; Jin H, Wang XW, and Li X supervised the research and acquired funding; Wang XW and Li X reviewed and edited the manuscript they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors reviewed and approved the final version for submission.
AI contribution statement: In the relevant documents responding to the reviewers’ comments, AI tools (Deepseek) was only used for language polishing (including grammar and spelling checks). It was not used for translation, data analysis, or any other form of writing assistance.
Supported by the Science and Technology Commission of Shanghai Municipality, China, No. 15411951700.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Shanghai Changhai Hospital, approval No. CHEC2020-021.
Informed consent statement: All participants provided written informed consent after receiving a detailed explanation of the study purpose, procedures, risks, benefits, and their rights.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The raw sequencing data generated in this study have been deposited in the China National Genebank (CNGB, https://db.cngb.org/cnsa/) under accession number CNP0001778. Non-sequencing raw data (including clinical records and imaging files) are subject to access restrictions in accordance with the Administrative Regulations of the People's Republic of China on Human Genetic Resources (http://www.gov.cn/zhengce/content/2019-06/10/content_5398829.htm). Processed analytical data (anonymized results) are available from the corresponding author upon reasonable request. Researchers may apply for access to restricted datasets by submitting a formal request to CNGBdb@cngb.org, specifying: (1) The study accession code (CNP0001778); (2) Detailed data requirements and (3) Intended research purpose.
Corresponding author: Xin Li, MD, Department of Thoracic Surgery, Changhai Hospital, No. 168 Changhai Road, Shanghai 200433, China. 717221600@qq.com
Received: March 12, 2026
Revised: March 30, 2026
Accepted: May 11, 2026
Published online: August 15, 2026
Processing time: 149 Days and 6.1 Hours
Abstract
BACKGROUND

Reliable biomarkers for esophageal squamous cell carcinoma (ESCC) are critically needed. While circulating tumor DNA (ctDNA) shows promise, its utility in ESCC requires further validation.

AIM

To evaluate ctDNA as a dynamic biomarker for real-time tumor burden assessment and prognostic stratification in ESCC.

METHODS

Matched plasma, leukocyte, and tumor tissues from 63 ESCC patients were analyzed. We employed a tumor-informed, TP53-specific ctDNA strategy, focusing on quantitative TP53 assessment to correlate postoperative ctDNA with clinical outcomes.

RESULTS

TP53 ranked as the gene most commonly found to be mutated. Preoperative TP53 ctDNA levels correlated with advanced T, N, and tumor-node-metastasis stages. Detection of TP53 ctDNA after surgery was associated with markedly poorer disease-free and overall survival. In neoadjuvant chemotherapy patients, post-treatment ctDNA status perfectly associated with pathological response. Multivariate analysis confirmed high preoperative TP53 ctDNA as an independent risk factor for recurrence. A tumor-agnostic analysis showed no prognostic value.

CONCLUSION

Quantitative TP53 ctDNA is a promising biomarker for real-time tumor response assessment and prognostic stratification in ESCC.

Keywords: Circulating tumor DNA; TP53; Esophageal squamous cell carcinoma; Tumor response; Variant allele frequency

Core Tip: Based on a study of 63 esophageal squamous cell carcinoma patients, quantitative analysis of TP53 circulating tumor DNA may help predict postoperative recurrence, assess response to neoadjuvant chemotherapy, and stratify patient survival, suggesting its potential value as a noninvasive biomarker for longitudinal monitoring.

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