• Yujiro Nishioka, Yun Shin Chun, Michael J Overman, CaoHop S TranHSTFrom the Departments of Surgical Oncology (Nishioka, Chun, Cao, Tzeng, Mason, Vauthey, Newhook), The University of Texas MD Anderson Cancer Center, Houston, TX., TzengChing-Wei DCDFrom the Departments of Surgical Oncology (Nishioka, Chun, Cao, Tzeng, Mason, Vauthey, Newhook), The University of Texas MD Anderson Cancer Center, Houston, TX., Meredith C Mason, Scott W Kopetz, Todd W Bauer, Jean-Nicolas Vauthey, Timothy E Newhook, and MD Anderson Cancer Center INTERCEPT Program.
• From the Departments of Surgical Oncology (Nishioka, Chun, Cao, Tzeng, Mason, Vauthey, Newhook), The University of Texas MD Anderson Cancer Center, Houston, TX.
• J. Am. Coll. Surg. 2022 Apr 1; 234 (4): 474-483.

BackgroundCirculating tumor DNA (ctDNA) is a promising biomarker for patients undergoing hepatectomy for colorectal liver metastases (CLM). We hypothesized that post-hepatectomy ctDNA detection would identify patients at highest risk for early recurrence of CLM.Study DesignPatients with CLM who underwent curative-intent hepatectomy with ctDNA analysis within 180 days postoperatively (1/2013 and 6/2020) were included. Tissue somatic mutations and ctDNA analyses were performed by next-generation sequencing panels. Survival analyses determined factors associated with clinical recurrence 1 year or earlier after hepatectomy. Patients with primary tumors in situ and without 1-year follow-up were excluded. Median follow-up was 28.3 months.ResultsOf 105 patients, 32 (30%) were ctDNA positive (ctDNA+) after curative-intent hepatectomy. Compared with ctDNA-negative patients, ctDNA+ patients had multiple CLM (84% vs 55%, p = 0.002) and co-mutated RAS/TP53 (47% vs 23%, p = 0.018). Multiple CLM (odds ration (OR), 5.43; p = 0.005) and co-mutated RAS/TP53 (OR, 3.30; p = 0.019) were independently associated with post-hepatectomy ctDNA. Although perioperative carcinoembryonic antigen levels were not prognostic, postoperative ctDNA+ (hazard ratio (HR), 2.04; p = 0.011) and extrahepatic disease (HR, 2.45, p = 0.004) were independently associated with worse recurrence-free survival. After adjusting for extrahepatic disease, preoperative chemotherapy, multiple CLM, tumor viability of 50% or greater, and co-mutated RAS/TP53, ctDNA+ within 180 days was the only independent risk factor for recurrence 1 year or earlier after hepatectomy (94% vs 49%; HR, 11.8; p = 0.003).ConclusionPostoperative ctDNA detection is associated with early recurrence 1 year or earlier after curative-intent hepatectomy for CLM, and RAS/TP53 co-mutations result in a more than 3-fold increased risk for postoperative ctDNA positivity. This highlights the complementary effect of tumor tissue and circulating mutational profiling for patients with CLM.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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