Beyond the conventional: the efficacy of liquid biopsy in post-therapeutic monitoring of oropharyngeal cancer, a meta-analysis

OBJECTIVES: This study aimed to evaluate the diagnostic and surveillance performance of circulating tumour human papillomavirus DNA for post-treatment monitoring of human papilloma virus-positive oropharyngeal squamous cell carcinoma. METHODS: Systematic review and meta-analysis of prospective studies (2019-2024) identified from PubMed, Web of Science and Scopus. Random-effects models were used to pool circulating tumour human papillomavirus DNA detectability and summarise lead-times to recurrence. RESULTS: Fifteen studies (n=1,447) were included; 10 cohorts (n=731) entered the quantitative meta-analysis. Pooled baseline detectability was 85.5 per cent (95 per cent confidence interval 78.2-90.6). Circulating tumour human papillomavirus DNA positivity preceded clinical recurrence by a mean of 76.8 days (median 87.5). Specificity and negative predictive value were consistently high, whereas sensitivity varied by assay platform and sampling frequency. CONCLUSION: Serial circulating tumour human papilloma virus DNA testing is a reliable adjunct to post-treatment surveillance in HPV-positive oropharyngeal squamous cell carcinoma, offering a clinically meaningful lead-time to recurrence. Standardised assays and multicentre validation are warranted.