Cancer Genetics and Epigenetics, 2025, Vol.13, No.6, 287-299 http://medscipublisher.com/index.php/cge 296 medical equity. Meanwhile, to truly incorporate ctDNA testing into routine clinical examinations, continuous investment is still needed in aspects such as laboratory construction, technical personnel training, and medical insurance reimbursement (Negro et al., 2025). Only by constantly resolving these economic and operational obstacles can more patients truly benefit from the treatment approach guided by ctDNA. 7.3 More large-scale prospective trials are needed to verify clinical efficacy Although retrospective studies and early prospective studies have confirmed the predictive role of ctDNA in the prognosis of colorectal cancer, to clarify its clinical application value, large-scale randomized controlled trials are still needed to support it. At present, most studies have deficiencies, such as small sample size, large differences in patient conditions, and inconsistent research designs, all of which have discounted the persuasiveness of the conclusions (Negro et al., 2025). There is a particular need to design scientific multi-center trials now to evaluate CTDNA-guided intervention programs - such as the effectiveness of increasing or decreasing adjuvant therapy in different conditions and among different populations. These tests also need to address key issues: When and how often is it most appropriate to test ctDNA? How can ctDNA testing be combined with other biomarker tests and imaging examinations? And what impact does this guidance plan have on the long-term survival and quality of life of patients (Hoang et al., 2025). Ongoing trials (including related studies in circulation and DYNAMIC projects) are expected to provide key data on the efficacy and safety of CTDNA-guided therapy (Hoang et al., 2025). In addition, future research should also focus on these aspects: Is ctDNA testing cost-effective? How should it be applied in medical systems with different resource conditions? What do patients think about ctDNa-based monitoring and treatment decisions (Negro et al., 2025)? With the development of this field, it is crucial to accumulate high-quality research evidence-this is related to the formulation of clinical guidelines, the approval of regulatory authorities, and the improvement of medical insurance reimbursement policies, ultimately enabling ctDNA to become a routine approach for personalized treatment of colorectal cancer. 8 Concluding Remarks The sensitivity and accuracy of circular tumor DNA (ctDNA) are both very high. It can effectively detect minimal residual lesions and predict recurrence, bringing breakthrough progress to postoperative monitoring of colorectal cancer. Many studies have demonstrated that a positive ctDNA test in patients after radical surgery is a key independent basis for evaluating recurrence-free survival - it often detects signs of recurrence several months earlier than conventional imaging examinations or the appearance of physical symptoms. By continuously monitoring ctDNA, doctors can more accurately determine the recurrence risk of patients than relying solely on traditional clinicopathological indicators, and thus take intervention measures earlier and more specifically. The advantages of ctDNA analysis in disease prediction and result stability highlight its potential as a non-invasive and real-time biomarker. In the future, in the diagnosis and treatment of colorectal cancer, it may even replace or complement the existing commonly used monitoring methods. The application of ctDNA test results in treatment decisions provides a new direction for improving postoperative adjuvant therapy for colorectal cancer. The treatment plan formulated based on ctDNA is highly flexible. For patients with detected ctDNA and a high possibility of recurrence, treatment can be strengthened. For low-risk patients without detected ctDNA, the dosage of chemotherapy drugs can be reduced or even chemotherapy can be waived. This can prevent over-treatment and adverse reactions caused by drugs. Both randomized trials and pooled analyses have shown that CtDNA-oriented treatment strategies can reduce the application of adjuvant chemotherapy without affecting the recurrence-free survival of patients, which provides support for the implementation of individualized and scientific treatment. In addition, regular monitoring of ctDNA during and after adjuvant therapy can reflect in real time whether the treatment is effective, helping doctors adjust the treatment plan in a timely manner. This approach is expected to improve the long-term quality of life of patients. As more large-scale trials continue to verify these strategies, ctDNA is expected to become an important foundation for individualized postoperative adjuvant therapy of colorectal cancer.
RkJQdWJsaXNoZXIy MjQ4ODYzNA==