Prognostic value of circulating tumor DNA in treated gastric cancer patients: A systematic review and meta-analysis.

Background

Multiple studies have demonstrated that circulating tumor DNA (ctDNA), a component of liquid biopsy, exhibits strong performance in predicting prognosis across various types of tumors. However, its role in predicting prognosis among gastric cancer patients undergoing treatment remains inconclusive. Therefore, this study aims to investigate the association between ctDNA and prognosis in gastric cancer patients receiving treatment through a meta-analysis.

Methods

A systematic literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases, with a search period ranging from the inception of each database to December 7, 2025. Relevant studies meeting the inclusion criteria were carefully selected and included. The primary outcome was the association between ctDNA status and overall survival (OS) in gastric cancer patients receiving treatment. Secondary outcomes included progression-free survival (PFS) and recurrence-free survival (RFS). Subgroup analyses were performed to assess the influence of factors such as ctDNA marker selection methods, ctDNA detection techniques, geographic region, and treatment modalities.

Results

A total of 17 primary studies involving 817 patients were included. The results indicated that the ctDNA status in treated gastric cancer patients was significantly associated with overall survival (HR = 3.95 [95% CI: 2.77-5.62]), progression-free survival (HR = 2.53 [95% CI: 1.84-3.47]), and recurrence-free survival (HR = 6.05 [95%CI:3.55-10.3]). Subgroup analyses further demonstrated that ctDNA positivity was associated with poorer overall survival outcomes.

Conclusion

ctDNA can serve as an effective prognostic biomarker for gastric cancer patients undergoing treatment, with broad application prospects in future clinical practice.