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Tyerman et al. J Cancer Metastasis Treat 2022;8:29 https://dx.doi.org/10.20517/2394-4722.2022.20 Page 5 of 9

Figure 1. Flow chart of study selection constructed with Preferred Reporting Items for Systematic Reviews and Meta-Analysis
(PRISMA) guidelines.

of treatment .
[34]
Kim et al. examined the association with concentration and fractional abundance of ctDNA KRAS
mutations at the time of diagnosis with outcomes in a study of 106 patients with PDAC . Of 41 patients
[35]
with resectable tumors, 35 (85%) were ctDNA+ at diagnosis. The KRAS mutation concentration of 0.165
copies/μL and a median fractional abundance of 0.415% were utilized as the cutoff to dichotomize “high” vs.
“low” in their dataset. Among those with resectable disease, patients with high KRAS mutation
concentration experienced significantly lower median progression-free survival (PFS, defined as the interval
from the day of diagnosis to the day of progression or death) compared to those in the low group (7 months
vs. not reached, P = 0.016); but no statistically significant difference in OS (8 months vs. not reached
P = 0.072). Similarly, patients with a high fractional abundance had a significantly shorter median PFS (7
months vs. not reached, P = 0.02) and similar OS (both did not reach 50% survival during the follow-up
period, P = 0.408) .
[35]

DISCUSSION
This systematic review highlights the utility of ctDNA as a prognostic indicator and biomarker in resectable
or potentially resectable pancreatic cancer in the pre- and postoperative setting. As high-quality prospective
studies continue to deliver additional data on the utility of this technology in pancreatic cancer, ctDNA has
the potential to become a standard of care biomarker, which may help to stratify risk for recurrence and
inform therapy decisions. Detection of ctDNA is accomplished within the normal clinical workflow. This