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Article History

Received: 11 August 2025

Accepted: 2 February 2026

First Online: 13 February 2026

Competing interests

: D.D.D.C. and S.V.B. are cofounders of Adela, serve in leadership positions, and own Adela shares. This arrangement has been reviewed and approved by the University Health Network in accordance with its conflict-of-interest policies. In addition, the University Health Network owns Adela equities. D.D.D.C. and S.V.B. are inventors in multiple patents related to cfDNA methylation profiling technology licensed to Adela and applied in this manuscript. D.D.D.C. is an inventor on PCT/CA2017/000108 (assignee, University Health Network) and PCT/CA2020/051507 (assignees, University Health Network, Van Andel Research Institute). D.D.D.C. and S.V.B. are inventors on PCT/CA2018/000141 (assignee, University Health Network) and PCT/CA2021/050842 (assignee, University Health Network). S.V.B. is also an inventor on a patent related to cfDNA mutation analysis technology outside of this work that has been licensed to Roche [PCT/US2014/025020 (assignee, Stanford University)]. E.Y.S-Z. provided consulting services for Adela. A.R. reports grants from Merck during the conduct of the study; grants from Adaptimmune, Bayer, GlaxoSmithKline, Medison, Inhibrx; research funding from Deciphera, Karyopharm Therapeutics, Pfizer, Roche/Genentech, Bristol Myers Squibb, MedImmune, Amgen, GlaxoSmithKline, Blueprint Medicines, Merck, AbbVie, Adaptimmune, Iterion Therapeutics, Neoleukin Therapeutics, Daiichi Sankyo, Symphogen, Rain Therapeutics, and Boehringer Ingelheim; and personal fees from Boehringer Ingelheim, Merck, Eli Lilly, and Medison outside the submitted work. A.S. reports grants and personal fees from Merck, BMS, grants from Novartis, Symphogen, AstraZeneca/Medimmune, Bayer, Surface Oncology, Janssen Oncology/Johnson & Johnson, Roche, Regeneron, Alkermes, Array Biopharma/Pfizer, GSK, NuBiyota, Oncorus, Treadwell, Amgen, ALX Oncology, Genentech, Seagen, Servier, Incyte, and Gilead outside the submitted work. P.S.O. is on scientific advisory boards for Providence Therapeutics, Tikva Allocell, and Rondo Therapeutics, Inc., and holds a sponsored research agreement with Providence Therapeutics. A.H. receives honoraria from Merck, Janssen, Astellas, Pfizer, Bayer; serves a consulting or advisory role for Astellas, Merck, Bayer, Eisai, Janssen; has institutional research funding from Merck, Bristol Myers Squibb, Janssen, Advancell, AVEO, SEAGEN, Macrogenics, Tyra-Biosciences, FUSION, Full Life Technologies; and has travel grants from Bayer. P.B. receives honoraria from Boehringer Ingelheim and research funding from Bristol Myers Squibb, Sanofi, AstraZeneca, Genentech/Roche, GlaxoSmithKline, Novartis, Merck, Seattle Genetics, Lilly, Amgen, Bicara, Zymeworks, Medicenna, Bayer, Takeda, Gilead Sciences, LegoChem Biosciences, Boehringer Ingelheim, ProteinQure, Daiichi Sankyo/UCB Japan. A.-R.H is a cofounder, chief medical officer, and serves in a leadership position at Adela; and owns Adela shares and reports Illumina shares. E.S.G. reports a relationship with GSK that includes consulting fees and grants from GSK and Rgenta Therapeutics. All Adela authors (Y.Z., C.A.M., E.D.L., M.A.H., Y.W., O.H., E.V.S., J.B.P., J.Z., A.L., A.W., B.A.A., J.Z.) report full-time employment and Adela stock options. L.L.S. acts as a consultant/advisory role for Merck, Pfizer, AstraZeneca, Roche, GSK, Voronoi, Arvinas, Navire, Relay, Marengo, Daiichi Sankyo, Amgen, LTZ Therapeutics, Tubulis, Marengo, Nerviano, Pangea, Velavigo, and Incyte; receives grant/research support from Merck, Novartis, Bristol Myers Squibb, Pfizer/SeaGen, Boerhinger Ingelheim, GlaxoSmithKline, Roche/Genentech, AstraZeneca/Medimmune, Bayer, Abbvie, Amgen, EMD Serono, Daiichi Sankyo, Gilead, Marengo, Incyte; is a founder and serves in a leadership position at Treadwell Therapeutics. All other authors declare no competing financial or non-financial competing interests.