基于ctDNA与MRD探讨亚肺叶切除术治疗早期周围型肺腺癌的围术期疗效评估OA

Objective:To evaluate the differences in surgical trauma and oncological efficacy between sublobar resection types for early-stage peripheral lung adenocarcinoma by monitoring plasma cell-free DNA(cfDNA),circulating tumor DNA(ctDNA),and minimal residual disease(MRD)levels.Methods:A retrospective analysis was conducted on the clinical data of 25 patients with stage IA peripheral lung adenocarcinoma who underwent sublobar surgery from January 2023 to June 2024.Among them,13 patients underwent segmentectomy(Lung_segment group)and 12 underwent wedge resection(Lung_wedge group).Tumor tissue was subjected to whole exome sequencing(WES)to screen for patient-specific high-frequency mutation sites(median 36).An individualized MRD monitoring panel was designed,and plasma ctDNA was detected using ultra-deep sequencing to evaluate MRD status.Peripheral blood samples were collected preoperatively and on postoperative day 3 to measure cfDNA concentration.Results:Among the 25 postoperative samples,ctDNA variants were detected in 3 cases,with only one variant identified in each of the positive samples.There was no statistically significant difference in the postoperative MRD-positive rate between the two groups(P>0.05).Postoperative cfDNA levels and their increment were significantly higher in the segmentectomy group than in the wedge resection group(P<0.05).Patients who developed postoperative pulmonary infections had significantly higher plasma cfDNA levels than those without infections(P<0.05).Conclusion:Segmentectomy is associated with a more significant surgical trauma response compared to wedge resection.The dynamic changes in postoperative cfDNA levels may serve as a potential biomarker for assessing tissue injury and predicting complications.