Prognostic Significance of Circulating Tumor DNA Detection and Quantification in Cervical Cancer: A Systematic Review and Meta-Analysis

Xiumin Zhao ¹ Shufu Hou ² Ruiqi Hao ³ Yelei Zang ⁴ Dan dan Song ^1*

• ¹ Department of Neurology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China., Jinan, Shandong Province, China
• ² Jinan Central Hospital Affiliated to Shandong First Medical University,Jinan, China, Jinan, China
• ³ Department of Gastrointestinal Surgery, Xintai City People's Hospital, Xintai, Shandong Province, China, Xintai, China
• ⁴ Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China

Background: Circulating tumor DNA (ctDNA) is an emerging biomarker in cervical cancer, with elevated levels typically indicating a higher tumor burden. However, its prognostic value in cervical cancer patients remains debated. This meta-analysis aims to clarify the prognostic significance of ctDNA in this patient population.We searched the PubMed, Cochrane Library, CNKI, and EMBASE databases for studies published up to September 30, 2024, to investigate the prognostic significance of ctDNA in cervical cancer patients. The outcome measures included overall survival (OS) and progression-free survival (PFS)/disease-free survival (DFS).Results: This analysis included 10 studies encompassing a total of 706 cervical cancer patients. Findings revealed that patients with detectable baseline ctDNA had significantly poorer OS(HR = 1.64, 95% CI = 1.45-1.86, P < 0.001) as well as worse PFS or DFS (HR = 1.42, 95% CI = 1.07 -1.89, P = 0.015). Additionally, ctDNA detectability during treatment was strongly associated with poorer OS (HR = 17.22, 95% CI = 4.43-66.89, P < 0.001) and PFS/DFS (HR = 4.16, 95% CI = 2.57-6.73, P < 0.001).This meta-analysis demonstrates that elevated ctDNA levels are significantly associated with poorer PFS, DFS, and OS in patients with cervical cancer. However, data regarding the association between ctDNA levels and OS are relatively limited, and the number of included studies remains small, with a potential risk of publication bias.Based on the current evidence, ctDNA shows promise as a valuable tool for pre-treatment assessment and an effective biomarker for monitoring therapeutic response and disease progression. Further large-scale, prospective studies are warranted to validate these findings and establish their reliability and clinical applicability.