{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:09:09Z","timestamp":1789124949719,"version":"build-2803163510"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stage II colon cancer is clinically heterogeneous. Current clinicopathologic risk factors cannot accurately identify patients with residual disease after curative resection. Circulating tumor DNA (ctDNA) has emerged as a promising biomarker for the detection of minimal residual disease (MRD), defined as microscopic residual tumor burden that remains after curative-intent treatment and is not detectable by conventional imaging, and for postoperative risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review summarizes the biological basis, analytical approaches, and clinical evidence regarding ctDNA in stage II colon cancer. We particularly emphasize prospective studies and randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperative ctDNA positivity is strongly associated with increased recurrence risk and provides superior prognostic stratification compared with conventional clinicopathologic factors. Prospective studies have demonstrated that ctDNA-positive patients experience substantially higher recurrence rates, with the GALAXY study reporting a hazard ratio of 11.99 (95% CI: 8.83\u201316.27) for disease-free survival among patients with postoperative molecular residual disease. The DYNAMIC trial demonstrated that ctDNA-guided management reduces adjuvant chemotherapy use without compromising recurrence-free survival. However, current evidence suggests an important asymmetry in clinical utility. ctDNA negativity may support treatment de-escalation. In contrast, ctDNA positivity has not yet reliably identified patients who benefit from treatment escalation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ctDNA constitutes a robust prognostic biomarker in stage II colon cancer and supports risk-adapted postoperative management. However, its predictive value for guiding treatment escalation remains unproven. Integration with clinicopathologic and molecular features is essential before routine clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1908802","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:43:22Z","timestamp":1789123402000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative circulating tumor DNA in stage II colon cancer: biological rationale, clinical evidence, and unresolved challenges"],"prefix":"10.3389","volume":"16","author":[{"given":"Erhua","family":"Yang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Yan\u2019An Hospital Affiliated to Kunming Medical University","place":["Kunming, China"]},{"name":"Nujiang People\u2019s Hospital","place":["Nujiang, 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