For people with colorectal cancer that has spread to the liver, surgery can sometimes remove all visible cancer. But even after a successful operation, there’s still a chance that microscopic cancer cells remain in the body and could cause the cancer to return.
A new study published in JAMA Oncology suggests that a simple blood test may help doctors better understand who is most likely to benefit from chemotherapy after surgery and who may be able to avoid additional treatment.
What did researchers study?
Researchers followed 282 people with colorectal liver metastases (CRLM) who underwent surgery to remove all detectable cancer. After surgery, participants had a circulating tumor DNA (ctDNA) blood test.
Unlike routine blood tests, ctDNA looks for tiny fragments of tumor DNA that may still be circulating in the bloodstream. Detecting ctDNA can be a sign that microscopic cancer cells—known as molecular residual disease (MRD)—remain in the body, even when scans show no evidence of cancer.
Researchers then compared outcomes for patients who received chemotherapy after surgery with those who were monitored without additional treatment.
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What did the study find?
The ctDNA test proved to be a powerful predictor of whether cancer would return after surgery.
About 1 in 3 patients had detectable ctDNA in their blood after surgery, suggesting that microscopic cancer cells remained despite having all visible cancer removed.
The differences in outcomes between patients with positive and negative ctDNA tests were striking:
- Patients with detectable ctDNA were more than four times as likely to experience cancer recurrence and more than nine times as likely to die during the study period compared with patients whose ctDNA test was negative.
- Four years after surgery, about 91% of patients with a negative ctDNA test were still alive, compared with 41% of patients whose ctDNA test was positive.
- Nearly 60% of ctDNA-negative patients remained cancer-free four years after surgery, compared with only 16% of patients with detectable ctDNA.
The researchers also found evidence that ctDNA could help identify who is most likely to benefit from chemotherapy after surgery.
Among patients with positive ctDNA tests, those who received chemotherapy had substantially better outcomes. Four years after surgery, 65% were still alive, compared with 33% of similar patients who did not receive chemotherapy.
In contrast, patients with negative ctDNA tests already had excellent long-term outcomes, with more than 90% alive four years later, regardless of whether they received chemotherapy. Researchers did not find a clear survival benefit from additional chemotherapy in this group.
Why is this important?
Today, deciding whether someone should receive chemotherapy after liver surgery isn’t always straightforward. Many patients receive chemotherapy because they’re considered at high risk for recurrence, but not everyone will benefit from the additional treatment.
One of the most exciting aspects of this research is that ctDNA wasn’t just identifying who was at higher risk—it also appeared to identify who actually benefited from chemotherapy. This is an important step toward more personalized cancer care, where treatment decisions are guided by what’s happening in an individual’s body rather than relying only on traditional risk factors, such as the size or number of tumors.
If future studies confirm these findings, ctDNA testing could help:
- Identify patients who may benefit from chemotherapy because they’re at higher risk of recurrence.
- Help some lower-risk patients safely avoid chemotherapy and its side effects.
- Give patients and their care teams greater confidence when making treatment decisions after surgery.
What does this mean for patients today?
While these findings are encouraging, ctDNA testing is still an evolving area of cancer care. Researchers continue to study exactly how these tests should be used to guide treatment decisions, and additional clinical trials are underway.
If you’ve been diagnosed with colorectal cancer that has spread to the liver—or you’ve recently had surgery to remove liver metastases—you may want to ask your oncologist:
- Is ctDNA testing appropriate for my situation?
- Would chemotherapy be expected to benefit me?
- Are there any clinical trials evaluating ctDNA-guided treatment that I may be eligible for?
While more research is needed before this approach becomes standard practice, the study offers hope for a future where treatment decisions are more precise, helping patients receive the care they’re most likely to benefit from while avoiding unnecessary treatment when possible.
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