Post-operative ctDNA-detected molecular residual disease in resected non-small cell lung cancer: A systematic review and meta-analysis of prognostic accuracy.

e20043 Background: Non-small cell lung cancer (NSCLC) continues to be the most common cause of cancer-related deaths globally, contributing to 85% of all lung cancer cases. Recurrence rates remain high despite complete surgical resection in patients with stage I to III NSCLC, despite appropriate postoperative therapy, occurring in 30-55% of patients. Thus, there is an urgent need for biomarkers like ctDNA to detect molecular residual disease (MRD). In light of the increasing but heterogeneous literature, there is a need for a comprehensive analysis of the prognostic performance of postoperative ctDNA-detected MRD in resected NSCLC. Methods: We searched PubMed, Embase, Scopus, ScienceDirect, and Cochrane from inception to January 2026, identifying 438 records. Eligible RCTs and observational studies reported postoperative ctDNA prognostic accuracy (sensitivity, specificity, NPV, PPV, AUC) and DFS HRs (ctDNA+ vs ctDNA-) in resected NSCLC. Data were pooled using RevMan 5.4 with random-effects models (P