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Sun Y, Zhang X, Yang X, Ma J. Clinical Utility of Circulating Tumor DNA for Detecting Lung Cancer Mutations by Targeted Next-Generation Sequencing With Insufficient Tumor Samples. J Clin Lab Anal 2024:e25099. [PMID: 39315762 DOI: 10.1002/jcla.25099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Circulating tumor deoxyribonucleic acid (ctDNA) is increasingly applied in clinical practice. This study aimed to explore clinical utility of a minimal invasive and sensitive way of ctDNA for next-generation sequencing in non-small cell lung cancer (NSCLC) with inadequate tumor samples. METHODS Targeted DNA sequencing was performed on tissue biopsies and matched plasma samples from 60 patients with NSCLC. RESULTS A total of 13 driving genes were detected in 60 matched tissue DNA (tDNA) and ctDNA samples. Overall concordance rate was 75.47%, with 77.55% sensitivity and 50% specificity. Epidermal growth factor receptor (EGFR) mutations were the most common in both tDNA and ctDNA samples. Among other mutated genes were tumor protein p53 (TP53), erb-b2 receptor tyrosine kinase 2 (ERBB2), anaplastic lymphoma kinase (ALK), cyclin-dependent kinase inhibitor 2A (CDKN2A), ros proto-oncogene 1, and receptor tyrosine kinase (ROS1). Mutations in b-raf proto-oncogene, serine/threonine kinase (BRAF), cluster of differentiation 274 (CD274), neurotrophin receptor tyrosine kinase 1 (NTRK1), and rearranged during transfection (RET) occurred only in plasma. The majority of mutations in both samples were single-nucleotide variants. Deletions were found in EGFR, BRAF, and TP53 in ctDNA, whereas in tDNA, deletions were only found in EGFR. In ALK, single nucleic acid-site amplification occurred simultaneously in tissue and plasma, but insertions and copy number variations were detected only in plasma. CONCLUSIONS Identifying ctDNA mutations by targeted sequencing in plasma is feasible, showing the clinical value of ctDNA-targeted sequencing in NSCLC patients when tumor tissue sampling is insufficient or even impossible.
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Affiliation(s)
- Yi Sun
- Pediatric, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xu Zhang
- Department of Molecular Diagnostics, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Xinhua Yang
- Department of Molecular Diagnostics, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Jiangjun Ma
- Department of Molecular Diagnostics, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, China
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Wang D, Wang SJ, Lababidi S. The impact of misclassification errors on the performance of biomarkers based on next-generation sequencing, a simulation study. J Biopharm Stat 2024; 34:700-718. [PMID: 37819021 DOI: 10.1080/10543406.2023.2269251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
The development of next-generation sequencing (NGS) opens opportunities for new applications such as liquid biopsy, in which tumor mutation genotypes can be determined by sequencing circulating tumor DNA after blood draws. However, with highly diluted samples like those obtained with liquid biopsy, NGS invariably introduces a certain level of misclassification, even with improved technology. Recently, there has been a high demand to use mutation genotypes as biomarkers for predicting prognosis and treatment selection. Many methods have also been proposed to build classifiers based on multiple loci with machine learning algorithms as biomarkers. How the higher misclassification rate introduced by liquid biopsy will affect the performance of these biomarkers has not been thoroughly investigated. In this paper, we report the results from a simulation study focused on the clinical utility of biomarkers when misclassification is present due to the current technological limit of NGS in the liquid biopsy setting. The simulation covers a range of performance profiles for current NGS platforms with different machine learning algorithms and uses actual patient genotypes. Our results show that, at the high end of the performance spectrum, the misclassification introduced by NGS had very little effect on the clinical utility of the biomarker. However, in more challenging applications with lower accuracy, misclassification could have a notable effect on clinical utility. The pattern of this effect can be complex, especially for machine learning-based classifiers. Our results show that simulation can be an effective tool for assessing different scenarios of misclassification.
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Affiliation(s)
- Dong Wang
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Sue-Jane Wang
- Office of Biostatistics, Center for Drug Evaluation Research, FDA, Maryland, USA
| | - Samir Lababidi
- Office of Data, Analytics and Research, Office of Digital Transformation, Office of Commissioner, FDA, Maryland, USA
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Ng HY, Ko JMY, Lam KO, Kwong DLW, Lo AWI, Wong IYH, Wong CLY, Chan SY, Chan KK, Law TT, Dai W, Fong HCH, Choy FSF, Lo CK, Chen C, Law SYK, Lung ML. Circulating Tumor DNA Dynamics as Prognostic Markers in Locally Advanced and Metastatic Esophageal Squamous Cell Carcinoma. JAMA Surg 2023; 158:1141-1150. [PMID: 37728901 PMCID: PMC10512170 DOI: 10.1001/jamasurg.2023.4395] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 09/22/2023]
Abstract
Importance Esophageal squamous cell carcinoma (ESCC) is a deadly disease with frequent recurrence. There are unmet needs for prognostic biomarkers for dynamically monitoring disease progression and detecting minimal residual disease. Objective To examine whether circulating tumor DNA is clinically useful as a prognostic biomarker for ESCC recurrence and patient survival. Design, Setting, and Participants This single-center, population-based cohort study consecutively enrolled 147 patients receiving curative (n = 74) or palliative (n = 73) treatment at the surgery and clinical oncology departments of Queen Mary Hospital in Hong Kong from August 1, 2016, to September 31, 2021. Patients were followed up for 2 years. Plasma samples were collected at different longitudinal time points for a prospective circulating tumor DNA (ctDNA) next-generation sequencing profiling study of 77 actionable genes. Intervention Patients were treated with up-front surgery, neoadjuvant chemoradiotherapy plus surgery with or without adjuvant therapy, or palliative chemotherapy (CT). Main Outcomes and Measures Detection of circulating tumor DNA (ctDNA), progression-free survival (PFS), and overall survival (OS). Results A total of 478 serial plasma samples from 147 patients with locoregional or metastatic ESCC were prospectively analyzed. Among the 74 patients in the curative group (median [range] age, 66 [46-85] years; 56 [76.0%] male), 44 (59.5%) relapsed and 36 (48.6%) died. For patients receiving curative surgical treatment, a high ctDNA level (hazard ratio [HR], 7.84; 95% CI, 1.87-32.97; P = .005) and ctDNA alterations (HR, 5.71; 95% CI, 1.81-17.97; P = .003) at 6 months postoperation were independently associated with poor OS. Among patients receiving neoadjuvant chemoradiotherapy, postneoadjuvant ctDNA alterations were associated with poor PFS (HR, 3.16; 95% CI, 1.17-8.52; P = .02). In the 73 patients in the palliative group (median [range] age, 63 [45-82] years; 63 [86.0%] male), 71 (97.3%) had disease relapse and 68 (93.2%) died. Detectable pre-CT NFE2L2 alterations were independently associated with PFS (HR, 2.99; 95% CI, 1.35-6.61; P = .007) and OS (HR, 28.39; 95% CI, 7.26-111.03; P = 1.52 × 10-6), whereas high ctDNA levels (HR, 2.41; 95% CI, 1.18-4.95; P = .02) and alterations in pre-cycle III ctDNA (HR, 1.99; 95% CI, 1.03-3.85; P = .04) showed weaker associations with PFS. Alterations in pre-CT ctDNA were independently associated with OS (HR, 4.46; 95% CI, 1.86-10.69; P = 7.97 × 10-4). Conclusions and Relevance The findings of this cohort study indicate that prognostic models incorporating ctDNA features are useful in ESCC. Both ctDNA level and NFE2L2 alterations pre-CT and before cycle III were found to be important prognostic factors in palliative groups, and ctDNA alterations after treatment and at 6 months after surgery may define high-risk groups for recurrence in the curative group. High-risk patients can benefit by a timely switch to the next therapeutic options.
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Affiliation(s)
- Hoi Yan Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Josephine Mun Yee Ko
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Ka On Lam
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Dora Lai Wan Kwong
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Anthony Wing Ip Lo
- Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Ian Yu Hong Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Claudia Lai Yin Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Siu Yin Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Kwan Kit Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Tsz Ting Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Wei Dai
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Henry Chun Hung Fong
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Faith Sin Fai Choy
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Chun Kit Lo
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Cancan Chen
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Simon Ying Kit Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Maria Li Lung
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
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Sayagués JM, Montero JC, Jiménez-Pérez A, Del Carmen S, Rodríguez M, Vidal Tocino R, Montero E, Sanz J, Abad M. Analysis of Circulating Tumor DNA in Synchronous Metastatic Colorectal Cancer at Diagnosis Predicts Overall Patient Survival. Int J Mol Sci 2023; 24:ijms24098438. [PMID: 37176143 PMCID: PMC10179090 DOI: 10.3390/ijms24098438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Sporadic colorectal cancer (sCRC) initially presents as metastatic tumors in 25-30% of patients. The 5-year overall survival (OS) in patients with metastatic sCRC is 50%, falling to 10% in patients presenting with synchronous metastatic disease (stage IV). In this study, we systematically analyzed the mutations of RAS, PIK3CA and BRAF genes in circulating tumor DNA (ctDNA) and tumoral tissue DNA (ttDNA) from 51 synchronous metastatic colorectal carcinoma (SMCC) patients by real-time PCR, and their relationship with the clinical, biological and histological features of disease at diagnosis. The highest frequency of mutations detected was in the KRAS gene, in tumor biopsies and plasma samples, followed by mutations of the PIK3CA, NRAS and BRAF genes. Overall, plasma systematically contained those genetic abnormalities observed in the tumor biopsy sample from the same subject, the largest discrepancies detected between the tumor biopsy and plasma from the same patient being for mutations in the KRAS and PIK3CA genes, with concordances of genotyping results between ttDNA and ctDNA at diagnosis of 75% and 84%, respectively. Of the 51 SMCC patients in the study, 25 (49%) showed mutations in at least 1 of the 4 genes analyzed in patient plasma. From the prognostic point of view, the presence and number of the most common mutations in the RAS, PIK3CA and BRAF genes in plasma from SMCC patients are independent prognostic factors for OS. Determination of the mutational status of ctDNA in SMCC could be a key tool for the clinical management of patients.
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Affiliation(s)
- José María Sayagués
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Networking Centers-Oncology (CIBERONC), 28029 Madrid, Spain
| | - Juan Carlos Montero
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Networking Centers-Oncology (CIBERONC), 28029 Madrid, Spain
| | - Andrea Jiménez-Pérez
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Networking Centers-Oncology (CIBERONC), 28029 Madrid, Spain
| | - Sofía Del Carmen
- Department of Pathology, University Hospital of Marqués de Valdecilla, 39008 Santander, Spain
| | - Marta Rodríguez
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Networking Centers-Oncology (CIBERONC), 28029 Madrid, Spain
| | - Rosario Vidal Tocino
- Department of Oncology and IBSAL, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Enrique Montero
- Department of Pathology, University Hospital of Zamora, 49071 Zamora, Spain
| | - Julia Sanz
- Department of Pathology, Puerto Real University Hospital, 11510 Cadiz, Spain
| | - Mar Abad
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Networking Centers-Oncology (CIBERONC), 28029 Madrid, Spain
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