In Reply We thank Zhao et al for their comments on our article1 and appreciate the opportunity to further discuss the value of circulating tumor DNA (ctDNA) analysis, focusing on 3 points raised by Zhao and colleagues. First, there is a fundamental difference between postoperative ctDNA and conventional prognostic markers.2 The presence of ctDNA indicates that the administered therapy (be it surgery, chemotherapy, radiotherapy, or immunotherapy) has not eradicated all cancer cells. For patients in whom the primary tumor was removed by surgical resection, the continuous presence of ctDNA means that millions of actively dividing cancer cells are present at occult metastatic sites within the body.
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Tie J, Vogelstein B, Gibbs P. Circulating Tumor DNA as a Prognostic Marker in Stage III Colon Cancer—Reply. JAMA Oncol. 2020;6(6):932–933. doi:10.1001/jamaoncol.2020.0289
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