DNA-Based Liquid Biopsy for Evaluating Surgical and Postsurgical Outcomes in Gynecologic Malignancies: A Systematic Review.

INTRODUCTION: DNA-based liquid biopsies, including circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA), are emerging as minimally invasive biomarkers for monitoring surgical and postsurgical outcomes in gynecologic malignancies. These tools offer the potential to guide early intervention, refine risk stratification, and improve prognostic accuracy. This systematic review aimed to assess the clinical utility of DNA-based liquid biopsies in evaluating recurrence, surgical success, and preoperative diagnosis in gynecologic cancers. METHODS: A systematic review was conducted in accordance with PRISMA guidelines, covering studies published from 2017 to 2025. Literature searches were performed in PubMed, Scopus, and Web of Science. A total of 32 eligible observational studies involving 3210 patients with ovarian, endometrial, uterine, and other gynecologic malignancies were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: The studies showed a broad geographic and methodological diversity, with a median NOS score of 7. CtDNA and cfDNA demonstrated promise in three key areas: (1) Recurrence prediction-postoperative ctDNA positivity was associated with higher relapse rates and reduced disease-free survival; (2) Monitoring surgical outcomes and treatment response-ctDNA dynamics more accurately reflected tumor burden than traditional markers like CA125; (3) Preoperative diagnostic support-cfDNA methylation profiling and cfDNA/CA125 models enhanced malignancy detection and risk stratification. Ovarian and endometrial cancers were most frequently studied. CONCLUSIONS: DNA-based liquid biopsies show strong potential in perioperative care for gynecologic cancers. Their integration into clinical workflows could improve the detection of minimal residual disease and inform individualized surgical planning.