SynthesisBreast cancer research and treatment2026
Post-neoadjuvant and peri-operative ctDNA-defined minimal residual disease in triple-negative breast cancer: a systematic review and meta-analysis.
Synthesis in Breast cancer research and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPost-neoadjuvant circulating tumor DNA (ctDNA) has been investigated as a minimal residual disease (MRD) marker in stage I-III triple-negative breast cancer (TNBC), but landmark timing and assay approaches vary.
objectivesTo assess whether post-neoadjuvant and/or peri-operative ctDNA MRD positivity is associated with poorer recurrence-related outcomes in TNBC with residual invasive disease, with overall survival evaluated as a secondary outcome and the association between ctDNA and pathologic complete response (pCR) assessed exploratorily.
methodsPubMed/MEDLINE, Embase, Web of Science Core Collection, and Scopus were searched through January 15, 2026. Eligible studies enrolled adults with TNBC treated with neoadjuvant systemic therapy and surgery and reported post-neoadjuvant or peri-operative ctDNA with time-to-event outcomes; recurrence-related quantitative syntheses focused on residual invasive disease or extractable non-pCR/residual cancer burden (RCB) subgroups. Risk of bias was assessed using QUIPS. Random-effects meta-analysis was performed when studies were comparable; otherwise, findings were summarized narratively.
resultsTwenty-two studies were included. Four studies contributed to the primary meta-analysis. Post-treatment ctDNA positivity was associated with poorer recurrence-related outcomes (pooled hazard ratio 4.63, 95% CI 3.07-6.98; I²=0%), although this estimate should be interpreted cautiously given the small number of contributing studies. Overall survival could not be synthesized quantitatively. Two studies assessed the ctDNA-pCR association, but results were summarized narratively because TNBC-specific data were not extractable in one study.
conclusionIn TNBC patients with residual invasive disease or extractable non-pCR/RCB subgroup data after neoadjuvant therapy, post-neoadjuvant and peri-operative ctDNA MRD positivity is associated with poorer recurrence-related outcomes, supporting further standardized prospective evaluation.
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