“The concentration of cell-free DNA (cfDNA) before and after surgery may be related to the prognosis of patients with CRC, but there is limited information regarding cfDNA levels at the time of surgery.”
Imagine if a single blood test could tell clinicians in real time how successful a cancer surgery has been. A recent study from the University of Brasília, published in Oncotarget, suggests that such an approach might soon be possible. By tracking changes in cell-free DNA (cfDNA) levels before, during, and after colorectal cancer (CRC) surgery, researchers have found a potential new way to monitor tumor removal and predict patient outcomes.
Cell-Free DNA and Colorectal Cancer Surgery
Cell-free DNA consists of tiny fragments of genetic material that are released into the bloodstream when cells break down. In healthy individuals, these fragments come from normal cell turnover, but in cancer patients, some of this DNA originates from tumor cells. cfDNA detection has been used to track cancer progression and treatment response in diseases like lung, breast, and CRC. What had not been investigated until now was how cfDNA levels fluctuate during cancer surgery itself.
Since surgery is the primary treatment for CRC, understanding how cfDNA levels change during surgical intervention could provide valuable insights into whether the tumor has been fully removed and how the patient’s body reacts to the procedure.
The Study: Measuring Cell-Free DNA in Real-Time
In the study, titled “Assessment of cfDNA release dynamics during colorectal cancer surgery,” led by first author Mailson Alves Lopes and corresponding author Fabio Pittella-Silva, scientists analyzed blood plasma samples from 30 CRC patients at three critical time points—before, during, and after surgery. Using highly sensitive genetic tests, they measured changes in cfDNA concentration to determine whether surgery had a direct impact on its release. The goal was to check whether cfDNA could serve as a biomarker for evaluating surgical effectiveness and predicting the probability of cancer recurrence.
The Challenge: Improving Colorectal Cancer Surgery Outcomes
Despite advances in CRC treatment, up to 50% of patients experience cancer recurrence after surgery. One of the greatest challenges in cancer care is determining whether surgery has successfully removed all cancer cells. Current methods rely on imaging scans and periodic biomarker testing, which can take months to detect any signs of recurrence.
A real-time way to assess surgical success, such as monitoring cfDNA levels, could transform how clinicians track cancer patients, allowing for more informed decisions about follow-up treatments and postoperative care.
The Results: A Significant Spike in Cell-Free DNA Levels
The researchers found that cfDNA levels increased nearly three times during surgery and remained elevated after the procedure. This increase was even more pronounced in specific groups of patients. People over 60, people who already had diabetes or heart disease, and people who had high levels of carcinoembryonic antigen (CEA), a known cancer marker, had the highest cfDNA spikes.
Patients with larger or more aggressive tumors showed even greater cfDNA release during surgery, likely due to increased tissue damage. Furthermore, surgeries that lasted longer were also linked to higher levels of cfDNA, suggesting that more cells are breaking down, leading to more genetic material entering the bloodstream.
The Breakthrough: A Potential Game-Changer in Colorectal Cancer Monitoring
This study is the first to show that cfDNA levels can reflect the extent of surgical intervention in real time. Monitoring cfDNA during surgery could help determine whether a tumor has been fully removed and whether additional treatment is needed. For instance, if cfDNA levels remain high after surgery, it could indicate the presence of cancer cells undetectable by regular imaging. Such findings could lead to earlier treatment and closer monitoring.
The Impact in Colorectal Cancer Treatment
If validated in further studies, cfDNA testing could become a standard tool in CRC surgery. Real-time tracking of cfDNA levels could help personalize postoperative care by identifying high-risk patients, guiding follow-up treatments, and detecting potential recurrence sooner. Additionally, cfDNA may serve as a quality marker for surgical procedures, ensuring better patient outcomes.
The Future Perspectives and Conclusion
While these findings are promising, further research is needed to standardize cfDNA testing for surgical monitoring. Larger clinical trials will be essential to confirm its ability to predict cancer recurrence and surgical success. With continued advancements, a simple blood test could soon help clinicians optimize cancer surgeries and improve patient outcomes, from the operating room to long-term recovery.
Click here to read the full research paper in Oncotarget.
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Oncotarget is an open-access, peer-reviewed journal that has published primarily oncology-focused research papers since 2010. These papers are available to readers (at no cost and free of subscription barriers) in a continuous publishing format at Oncotarget.com.
Oncotarget is indexed and archived by PubMed/Medline, PubMed Central, Scopus, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science).
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