Even when treatment is successful, relapse is still a significant threat to many cancer patients, and it is hard to detect the residual disease in time using imaging or tissue biopsy. Very few effective and reliable markers are available currently. Recent studies demonstrated that ctDNA assays were able to detect residual disease several weeks earlier than radiologic imaging [30], and ctDNA-positive patients were at higher risk of relapse and exhibited worse outcome (like shorter overall survival and disease-free survival time) compared to the ctDNA-negative group [31]. In addition, it was shown that phylogenetic ctDNA profiling could be used to track the subclonal nature of lung cancer relapse and metastasis [15]. With the collected profiles, cancer patients could be stratified into different adjuvant therapies to prevent overtreatment [12].
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