Article
Assessment of a direct fluorescence‑based cell‑free DNA assay for evaluating the extent of metastatic dissemination: An exploratory study
- Authors:
- Jae-Joon Kim
- Yangjeong Lee
- Yun Jeong Hong
- Kwonoh Park
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Affiliations:
Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Gyeongsangnam‑do 50612, Republic of Korea, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam‑do 50612, Republic of Korea, Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Republic of Korea, Division of Hematology & Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi‑do 10326, Republic of Korea
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Article Number:
141
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Published online on:
October 9, 2026
https://doi.org/10.3892/br.2026.2214
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Abstract
Fluorescence‑based cell‑free DNA (cfDNA) assays quantify nucleic acids without the need for DNA extraction and amplification. The present study investigated whether cfDNA levels differed between patients with active cancer and those with no evidence of disease (NED). Blood samples from patients with metastatic cancer (Patient group) and from individuals with NED (patients that had completed curative‑intent treatment and remained recurrence free for ≥1 year; NED group) were used to quantify cfDNA levels using PicoGreen™ reagent. In total, 124 participants were prospectively enrolled between January 2020 and August 2021 (Patient group, n=72; NED group, n=52). The median age was 69 years (range: 27‑83 years) in the Patient group and 65 years (range: 34‑81 years) in the NED group. In the Patient group, the pancreatobiliary (n=32, 44.4%), genitourinary (n=20, 27.7%) and gastrointestinal (n=6, 8.3%) sites were the most common primary cancer sites. The median cfDNA value in the Patient group (9.80 µg/ml, IQR 8.63‑11.08) was significantly higher than that in the NED group (8.40 µg/ml, IQR 7.75‑9.10, P<0.001). In addition, the median cfDNA levels were significantly higher in patients with a high extent of metastatic dissemination (defined as metastases in three or more organs) than in those with a low tumor extent (10.70 µg/ml, IQR 9.35‑12.4 vs. 9.45 µg/ml, IQR 8.48‑10.85, respectively; P=0.027). Notably, there was no significant correlation between cfDNA and conventional tumor marker levels, including carcinoembryonic antigen and carbohydrate antigen 19‑9 levels (P=0.468 and P=0.134, respectively). These findings indicated that cfDNA levels were elevated in patients with metastatic cancer compared with those with NED, particularly in those with a higher extent of metastatic dissemination. Additionally, cfDNA levels were not correlated with those of conventional tumor markers. These cross‑sectional exploratory data highlight the potential utility of fluorescence‑based cfDNA assays in assessing the extent of metastatic dissemination, and provide a foundational rationale for future longitudinal studies investigating treatment monitoring and prognosis.
