SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Thoracic Oncology
This article is part of the Research TopicLiquid Biopsy in Non-Small Cell Lung Cancer for Diagnosis, Treatment Selection and MonitoringView all 4 articles
ctDNA clearance predicts survival in unresectable EGFR-mutant NSCLC: a meta-analysis
Provisionally accepted
- 1Department of Oncology, Heilongjiang Beidahuang Group General Hospital, Harbin, China
- 2Department of Respiratory and Critical Care Medicine, Heilongjiang Beidahuang Group General Hospital, Harbin, China
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Background: Circulating tumor DNA (ctDNA) is a non-invasive biomarker for monitoring non-small cell lung cancer (NSCLC). In EGFR-mutant NSCLC, ctDNA clearance during EGFR-TKI therapy is linked to improved outcomes. Methods: A systematic review was conducted following PRISMA guidelines, with data from PubMed, EMBASE, Web of Science, and Cochrane Library up to September 2025. Eligible studies were prospective cohorts or randomized trials reporting ctDNA dynamics and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Results: Four studies involving a total of 336 patients met the inclusion criteria.. Pooled analysis showed ctDNA clearance was significantly associated with prolonged PFS (HR = 0.34) and OS (HR = 0.29). Sensitivity analyses confirmed the robustness, and no significant publication bias was detected. Conclusions: ctDNA clearance during EGFR-TKI treatment appears to be associated with improved survival outcomes in patients with EGFR-mutant NSCLC. These findings suggest that ctDNA dynamics may serve as a promising early prognostic biomarker, although further validation in larger prospective studies and standardization of ctDNA assays, sampling time points, and clearance definitions are required.
Keywords: ctDNA clearance, EGFR mutations, Meta-analysis, Non-small cell lung cancer, prognostic biomarker
Received: 10 Nov 2025; Accepted: 28 Jan 2026.
Copyright: © 2026 Li, Zhang, Qin and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rui Li
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