Guo XW, Xu XX, Deng BJ, Zhou GF, Zhou Q, Gao XX, Du CZ, Qiao Z, Li HT. Harnessing minimal residual disease for precision medicine in locally advanced gastric cancer. World J Clin Oncol 2026; 17(7): 121993 [DOI: 10.5306/wjco.121993]
Corresponding Author of This Article
Hong-Tao Li, Associate Chief Physician, Associate Professor, Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, No. 333 South River Road, Lanzhou 730050, Gansu Province, China. lihongtao528@163.com
Research Domain of This Article
Oncology
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review-article
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Guo XW, Xu XX, Deng BJ, Zhou GF, Zhou Q, Gao XX, Du CZ, Qiao Z, Li HT. Harnessing minimal residual disease for precision medicine in locally advanced gastric cancer. World J Clin Oncol 2026; 17(7): 121993 [DOI: 10.5306/wjco.121993]
World J Clin Oncol. Jul 24, 2026; 17(7): 121993 Published online Jul 24, 2026. doi: 10.5306/wjco.121993
Harnessing minimal residual disease for precision medicine in locally advanced gastric cancer
Xiao-Wei Guo, Xin-Xin Xu, Bing-Jie Deng, Guang-Fu Zhou, Qian Zhou, Xiao-Xin Gao, Cheng-Zhou Du, Zhi Qiao, Hong-Tao Li
Xiao-Wei Guo, Xin-Xin Xu, Guang-Fu Zhou, Qian Zhou, Xiao-Xin Gao, Cheng-Zhou Du, Hong-Tao Li, Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Bing-Jie Deng, The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730101, Gansu Province, China
Zhi Qiao, Department of General Surgery and Institute of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Xiao-Wei Guo and Xin-Xin Xu.
Co-corresponding authors: Zhi Qiao and Hong-Tao Li.
Author contributions: Guo XW and Xu XX conceived and designed the review; Deng BJ, Zhou GF, and Gao XX performed the literature search, screened relevant studies, and extracted key information; Guo XW drafted the initial manuscript; Xu XX, Qiao Z, and Li HT critically revised the manuscript for important intellectual content; Zhou Q and Du CZ provided methodological guidance and supervision; Guo XW and Xu XX made equal contributions to the work as the co-first authors; Qiao Z and Li HT made equal contributions to the work as the co-corresponding authors. All authors have read and approved the final manuscript.
AI contribution statement: We would like to clarify that ChatGPT was used only as a supportive language tool for limited grammar checking and minor language refinement of certain sentences during manuscript preparation. The tool was not used to generate scientific content, results, interpretations, or figures. All intellectual content, analysis, and conclusions were fully developed by the authors.
Supported by Military Health Care Project, No. 24BJZ15; and Gansu Provincial Science and Technology Project, No. 25JRRA1191.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Hong-Tao Li, Associate Chief Physician, Associate Professor, Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, No. 333 South River Road, Lanzhou 730050, Gansu Province, China. lihongtao528@163.com
Received: April 8, 2026 Revised: June 10, 2026 Accepted: June 25, 2026 Published online: July 24, 2026 Processing time: 107 Days and 14 Hours
Abstract
Gastric cancer remains a major cause of cancer-related mortality, and recurrence after radical-intent therapy is a central obstacle in locally advanced gastric cancer (LAGC). Minimal residual disease (MRD) refers to occult residual tumor burden that cannot be detected by conventional imaging or routine laboratory tests but may later drive recurrence. Circulating tumor DNA (ctDNA), a tumor-derived fraction of circulating cell-free DNA that is mainly released into the bloodstream during tumor-cell apoptosis and necrosis, has emerged as a promising non-invasive biomarker for MRD assessment. In LAGC, ctDNA-MRD detection may support recurrence-risk stratification, postoperative surveillance, molecular response assessment after neoadjuvant therapy, and exploratory evaluation of treatment efficacy, including immunotherapy. However, current evidence should be interpreted cautiously. Most available studies are observational, include modest cohorts, use heterogeneous assay platforms and sampling schedules, and apply non-uniform thresholds for MRD positivity. Therefore, the best-supported role of ctDNA-MRD in LAGC is currently prognostic rather than definitively predictive or treatment-directing. This narrative review summarizes the biological basis of ctDNA, major polymerase chain reaction- and next-generation sequencing-based detection strategies, representative clinical evidence in LAGC, and the main barriers to clinical implementation. CtDNA-MRD assessment has substantial potential to refine precision management in LAGC, but routine treatment modification based solely on ctDNA status requires prospective, interventional validation and standardized analytical workflows.
Core Tip: Locally advanced gastric cancer remains difficult to cure because occult residual disease can drive recurrence after radical or multimodal therapy. Minimal residual disease (MRD) assessment using circulating tumor DNA (ctDNA) offers a non-invasive strategy for molecular surveillance, recurrence-risk stratification, and dynamic evaluation of treatment response. This minireview highlights current ctDNA-MRD technologies, introduces tumor-informed and tumor-agnostic approaches, and clarifies that ctDNA-MRD is promising but still investigational for treatment guidance. Standardized assays, validated thresholds, and prospective interventional trials are needed before routine precision management of locally advanced gastric cancer.
