Clinical Significance of a Circulating Tumor Cell-based Classifier in Stage IB Lung Adenocarcinoma: A Multicenter, Cohort Study.
Clinical Significance of a Circulating Tumor Cell-based Classifier in Stage IB Lung Adenocarcinoma: A Multicenter, Cohort Study.
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基于循环肿瘤细胞的分类器在 IB 期肺腺癌中的临床意义：一项多中心队列研究
DOI：
10.1097/sla.0000000000004780
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发表时间：
2023-02-01
影响因子：
9
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目的：探讨基于CTC的分类器在IB LUAD分层阶段的有效性。IB期LUAD的5年存活率约为70%。由于一系列试验的结果不一致，且缺乏有用的生物标志物，ACT的临床应用存在争议。因此，迫切需要强有力的生物标志物来对IB期患者进行分层，以确定哪一组患者最有可能从ACT中受益。方法：将212例IB期LUAD患者分为3个独立队列。采用适体修饰的纳米尼龙搭扣体系对CTCs进行了富集化。以<；4或>；4 CTC作为IB期LUAD的最佳预后阈值，将70名患者分为低风险组和高风险组。在训练队列中，≥-4 CTC患者的无进展生存期(P<；0.0001)和总生存期(P<；0.0001)均短于<；4 CTC患者。即使在包括其他临床病理参数的多变量分析中，CTC数值仍然是无进展生存期和总生存期的最强预测因子。此外，基于四氯化碳计数的诺模图被用来预测训练队列中的3年和5年存活率，并在其他2个验证队列中表现良好(C指数：0.862、0.853和0.877)。>；4CTC的存在可以定义高危亚组，为IB期LUAD提供了一种新的临床决策。
To investigate the effectiveness of a CTC-based classifier in stratifying stage IB LUAD. Stage IB LUADs have an approximately 70% 5-year survival rate. The clinical application of ACT is controversial due to inconsistent results in a series of trials and few useful guide biomarkers. Thus, there is a pressing need for robust biomarkers to stratify stage IB patients to define which group would most likely benefit from ACT. Methods: Two hundred twelve stage IB LUAD patients were enrolled and were divided into 3 independent cohorts. The aptamer-modified NanoVelcro system was used to enrich the CTCs. A cutoff of <4 or >4 CTCs as the optimal prognostic threshold for stage IB LUAD was generated to stratify the patients in a 70-patient cohort into low-risk and high-risk groups. Patients with ≥ 4 CTCs in the training cohort had shorter progression-free survival (P < 0.0001) and overall survival (P < 0.0001) than patients with <4 CTCs. CTC number remained the strongest predictor of progression-free survival and overall survival even in a multivariate analysis including other clinicopathological parameters. Furthermore, a nomogram based on the CTC count was developed to predict the 3-year and 5-year survival in the training cohort and performed well in the other 2 validation cohorts (C-index: 0.862, 0.853, and 0.877). The presence of >4 CTCs can define a high-risk subgroup, providing a new strategy to make optimal clinical decisions for stage IB LUAD.