Abstract
A synthetic cohort of 1,000 malignant peripheral nerve sheath tumor (MPNST) cases, equally distributed between retroperitoneal and cervicofacial locations, was analyzed to evaluate the relationship between circulating tumor DNA (ctDNA), tumor burden, surgical complexity, and recurrence. Retroperitoneal tumors showed larger size and volume, higher frequency of high-grade disease, and greater preoperative ctDNA levels. Preoperative ctDNA demonstrated discriminatory ability for baseline metastasis (AUC = 0.818) and high histological grade (AUC = 0.764). Although postoperative ctDNA persistence was initially associated with recurrence, it lost independent significance after multivariable adjustment, whereas R1/R2 margins, baseline metastasis, and high-grade disease remained significant predictors. Longitudinal analysis showed decreasing ctDNA levels in non-recurrent cases and increasing levels in recurrent cases. These findings reflect the behavior of a synthetic model and require validation using real clinical data.
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