Background/Objectives: Circulating tumor DNA (ctDNA) has emerged as a promising biomarker for non-invasive tumor monitoring in diffuse large B-cell lymphoma (DLBCL). Methods: In this study, 52 patients with newly diagnosed advanced-stage DLBCL treated with R-CHOP underwent serial ctDNA analysis at baseline, interim (after three cycles), and end of treatment. The prognostic significance of ctDNA dynamics was evaluated, and its predictive value was compared with the PET/CT response. Results: Targeted next-generation sequencing revealed baseline ctDNA in 98.1% of patients, with 74.7% concordance to tumor tissue genotyping. Higher baseline ctDNA levels correlated with elevated LDH, older age, and high IPI scores. A ≥2-log reduction in ctDNA at interim was significantly associated with improved overall survival (p= 0.004), though not with progression-free survival. Notably, combining interim ctDNA dynamics with PET/CT results enhanced the predictive accuracy for treatment outcomes, particularly among patients with partial metabolic responses. Conclusions: These findings support the clinical utility of ctDNA for dynamic risk assessment in DLBCL, and suggest that integrating ctDNA with imaging biomarkers may guide more personalized therapeutic strategies. Further validation using highly sensitive ctDNA assays is warranted to optimize its role in routine clinical practice.
背景/目的：循环肿瘤DNA（ctDNA）已成为弥漫性大B细胞淋巴瘤（DLBCL）无创肿瘤监测的重要生物标志物。方法：本研究对52例接受R-CHOP方案治疗的新诊断晚期DLBCL患者，在基线期、中期（三个周期后）和治疗结束时进行连续ctDNA检测。评估ctDNA动态变化的预后意义，并将其预测价值与PET/CT疗效评估进行比较。结果：靶向二代测序显示98.1%的患者存在基线ctDNA，与肿瘤组织基因分型的一致性达74.7%。较高的基线ctDNA水平与乳酸脱氢酶升高、年龄增长及高国际预后指数评分相关。中期ctDNA降低≥2个数量级与总生存期改善显著相关（p=0.004），但与无进展生存期无显著关联。值得注意的是，将中期ctDNA动态变化与PET/CT结果相结合，可提高治疗结局的预测准确性，尤其对于部分代谢缓解患者。结论：本研究证实ctDNA在DLBCL动态风险评估中具有临床价值，提示ctDNA与影像生物标志物的整合可能指导更个体化的治疗策略。未来需采用高灵敏度ctDNA检测技术进一步验证，以优化其在常规临床实践中的应用。
肿瘤(癌症)患者之家