# Tracking early lung cancer metastatic dissemination in TRACERx using ctDNA

Source: https://onco.cc/key-papers/paper-abbosh-tracerx-ctdna-relapse-nature-2023/  
OnCo record `paper-abbosh-tracerx-ctdna-relapse-nature-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Tracking about 200 of each patient's own tumour mutations in blood after lung cancer surgery found tumour DNA in half of those who later relapsed from one sample, and in more with repeated testing.

## Summary

The TRACERx team tracked a median of 200 mutations identified in resected non-small-cell lung cancer across 1,069 plasma samples from 197 patients. Lung adenocarcinomas with no circulating tumour DNA before surgery were biologically indolent with good outcomes. In plasma taken within 120 days after surgery, tumour DNA was detected in 25 per cent of patients, including 49 per cent of all who went on to relapse; surveillance every three to six months identified impending relapse in a further 20 per cent of patients who were negative at that landmark.

A bioinformatic tool, ECLIPSE, tracked subclonal architecture at low tumour DNA levels and identified patients with polyclonal metastatic dissemination, which was associated with a worse clinical outcome. Subclones that seeded future metastases were more expanded in preoperative plasma than non-metastatic ones.

## Fields

- Kind: Key paper
- Last checked: 2026-10-20
- Tags: precision
- Journal: Nature
- Year: 2023
- DOI: 10.1038/s41586-023-05776-4
- Authors: Abbosh C, Frankell AM, Harrison T, et al.
- Findings: Postoperative landmark plasma (within 120 days) positive in 25 per cent of patients, including 49 per cent of those who relapsed.; Three- to six-monthly surveillance detected impending relapse in a further 20 per cent of landmark-negative patients.; No preoperative tumour DNA marked biologically indolent lung adenocarcinoma with good outcomes.
- What it means: One negative blood test after surgery misses about half of the people who will relapse, even with a very broad tumour-informed panel; repeated testing catches more. The test's sensitivity is limited by how much DNA the tumour sheds, not only by the assay.
- Caveats: Research assay tracking a median of 200 mutations, broader than most commercial tests.; Observational: results did not change treatment.

## Sources

- Abbosh et al., Nature 2023: https://doi.org/10.1038/s41586-023-05776-4
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37055640/

## Connected records

- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- trials: [TRACERx](https://onco.cc/trials/tracerx/)
- journals: [Nature](https://onco.cc/journals/nature/)

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