Evidence status: Prospective multicentre observational study / exploratory analysis
Study design
The prospective multicentre PRECISION observational study enrolled 118 previously untreated patients with resectable colorectal-cancer distant metastases. It combined preoperative ctDNA comprehensive genomic profiling (CGP) with postoperative week-4 ctDNA minimal residual disease (MRD).
Key results
- Preoperative ctDNA was detected in 114/118 patients (96.6%).
- A poor-prognosis genomic profile was found in 75/118 (63.6%).
- Among 109 patients who underwent surgery, postoperative MRD was positive in 34/109 (31.2%).
- Poor preoperative profile plus postoperative MRD positivity versus neither: RFS HR 13.28, unresectable recurrence HR 8.98 and OS HR 9.21.
- Patients with neither marker had 77.8% two-year RFS and 93.0% three-year OS.
Potential value
The two blood-based layers may refine recurrence-risk stratification after metastasectomy beyond imaging alone, with potential relevance to surveillance and clinical-trial design.
Limitations
This was a small, non-randomised observational study. The analysis was exploratory and hypothesis-generating. It did not prove that changing treatment according to these tests improves survival, nor establish routine availability, reimbursement or international-patient access.
This information does not replace diagnosis or treatment. Test availability, reimbursement and clinical decisions require confirmation with the treating institution.