ctDNA在非小细胞肺癌精准治疗中的临床前沿与应用进展OA

Circulating tumor DNA(ctDNA)enables minimally invasive,repeatable assessment of tumor burden and molecular evolution and is an important candidate biomarker for precision management of non-small cell lung cancer(NSCLC).This review summarizes current evidence on assay strategies,perioperative dynamics,molecular residual disease(MRD)after curative-intent treatment,relapse surveillance,and applications in unresectable stage Ⅲ disease.The most consis-tent evidence shows that detectable ctDNA after definitive treatment is associated with a substantially increased risk of recur-rence,whereas longitudinally undetectable MRD identifies lower-risk populations more reliably than a single negative result.ctDNA clearance during neoadjuvant therapy is associated with pathological response and long-term outcomes but cannot re-place pathology or imaging.In oncogene-driven disease,epidermal growth factor receptor(EGFR)-mutated NSCLC has MRD evidence from samples collected in a randomized trial;a small prospective postoperative study has provided direct MRD evi-dence in early-stage anaplastic lymphoma kinase(ALK)-or ROS proto-oncogene 1,receptor tyrosine kinase(ROS1)-fusion-positive disease,although the evidence base remains limited;Kirsten rat sarcoma viral oncogene homolog(KRAS),GTPase specific postoperative MRD studies remain insufficient.When pathology,imaging,and ctDNA are discordant,assay validity should first be confirmed and lesion-directed imaging or tissue confirmation pursued according to the suspected relapse pat-tern;ctDNA alone should not trigger deviation from standard therapy.ctDNA has substantial clinical validity,but routine treat-ment decisions still require standardized analytical performance,cross-platform reproducibility,and prospective evidence of clinical utility.