SynthesisFrontiers in oncology2026
Circulating tumor DNA and prognosis in gastric cancer patients undergoing surgery: meta-analysis and trial sequential analysis.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Perioperative Circulating Tumor DNA in Resectable Gastric and Gastroesophageal Junction Adenocarcinoma: Molecular Residual Disease, Recurrence Prediction, and a Trial-Ready Framework for Treatment Adaptation.Journal of gastrointestinal cancer · 2026Review
- Liquid Biopsy for Molecular Residual Disease Detection and Postoperative Surveillance in Gastric Cancer: Current Evidence and Future Directions.International journal of molecular sciences · 2026Review
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Circulating tumor DNA (ctDNA) is a promising biomarker for monitoring minimal residual disease (MRD) and recurrence risk in gastric cancer. Prior meta-analyses were limited by heterogeneous cohorts, inconsistent HR extraction, and lack of trial sequential analysis (TSA). This study provides an updated, methodologically rigorous synthesis focusing exclusively on resectable gastric cancer. Methods: A systematic search of four major databases was performed to May 2025 (PROSPERO: CRD42025107578). Eligible studies included surgically treated gastric cancer patients with perioperative ctDNA assessment and reported hazard ratios (HRs) for overall survival (OS) or disease-free survival (DFS). Multivariate Cox HRs were prioritized, with one HR extracted per time window to ensure independence. Random-effects models, subgroup and sensitivity analyses, and publication bias assessments were conducted in R 4.5.0. TSA used O'Brien-Fleming monitoring boundaries to evaluate evidence sufficiency. Results: Twenty-five studies (60 datasets) were included. ctDNA positivity was associated with significantly worse OS (HR = 2.31, 95% CI 1.78-3.00) and DFS (HR = 2.36, 95% CI 1.69-3.29). Subgroup analyses showed consistent effects across detection platforms, sample sources, regions, and stages. Post-operative ctDNA demonstrated stronger prognostic value than pre-operative measurements for both OS (HR = 3.47 vs. 1.99) and DFS (HR = 4.14 vs. 1.97). Results were robust in sensitivity analyses. Publication bias was present for OS but did not materially alter pooled estimates. TSA showed that cumulative Z-curves crossed the O'Brien-Fleming boundaries and met or exceeded the required information size. Conclusion: ctDNA positivity reliably predicts poorer postoperative survival in resectable gastric cancer, with post-operative ctDNA providing the strongest prognostic signal. TSA confirms that current evidence is sufficiently conclusive to support clinical relevance. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025107578.
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