Pooled Analysis of the Prognostic Relevance of Circulating Tumor Cells in Primary Breast Cancer
Pooled Analysis of the Prognostic Relevance of Circulating Tumor Cells in Primary Breast Cancer
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DOI：
10.1158/1078-0432.ccr-15-1603
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发表时间：
2016-05-15
影响因子：
11.5
通讯作者：
Lucci, Anthony
中科院分区：
文献类型：
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作者：
Janni, Wolfgang J.;Rack, Brigitte;Lucci, Anthony
目的：尽管有明确的证据表明转移性乳腺癌患者外周血中循环肿瘤细胞（CTC）的预后相关性，但在初步诊断时CTCs的预后相关性的证据较少。实验设计：我们对来自五个乳腺癌机构的3，173名非转移性（I-III期）乳腺癌患者的个体数据进行了汇总分析。在初步诊断时，使用FDA批准的CellSearch系统（Janssen Diagnostics，LLC）评估CTC的患病率和数量。采用荟萃分析程序、单变量对数秩检验和多变量考克斯比例风险回归分析对患者结局进行分析。中位随访时间为62.8个月。结果：20.2%的患者检测到一个或多个CTC。与CTC阴性患者相比，CTC阳性患者的肿瘤更大，淋巴结受累更多，组织学肿瘤分级更高（均P < 0.002）。多变量考克斯回归分析，包括肿瘤大小、淋巴结状态、组织学肿瘤分级、激素受体和HER 2状态，证实CTC的存在是无病生存期[HR，1.82; 95%置信区间（CI），1.47-2.26]、无远处转移生存期[HR，1.82; 95%置信区间（CI），1.47-2.26]和无远处转移生存期[HR，1.82; 95%置信区间（CI），1.47-2.26]的独立预后因素。（HR，1.89; 95% CI，1.49-2.40），乳腺癌特异性生存期（HR，2.04; 95% CI，1.52-2.75）和总生存期（HR，1.97; 95% CI，1.51-2.59）。在原发性乳腺癌患者中，CTC的存在是无病生存率、总体生存率、乳腺癌特异性生存率和远处无病生存率较差的独立预测因素。(C)2016年AACR。
Purpose: Although unequivocal evidence has shown the prognostic relevance of circulating tumor cells (CTC) in the peripheral blood of patients with metastatic breast cancer, less evidence is available for the prognostic relevance of CTCs at the time of primary diagnosis.Experimental Design: We conducted a pooled analysis of individual data from 3,173 patients with nonmetastatic (stage I-III) breast cancer from five breast cancer institutions. The prevalence and numbers of CTCs were assessed at the time of primary diagnosis with the FDA-cleared CellSearch System (Janssen Diagnostics, LLC). Patient outcomes were analyzed using meta-analytic procedures, univariate log-rank tests, and multivariate Cox proportional hazard regression analyses. The median follow-up duration was 62.8 months.Results: One or more CTCs were detected in 20.2% of the patients. CTC-positive patients had larger tumors, increased lymph node involvement, and a higher histologic tumor grade than did CTC-negative patients (all P < 0.002). Multivariate Cox regressions, which included tumor size, nodal status, histologic tumor grade, and hormone receptor and HER2 status, confirmed that the presence of CTCs was an independent prognostic factor for disease-free survival [HR, 1.82; 95% confidence interval (CI), 1.47-2.26], distant disease-free survival (HR, 1.89; 95% CI, 1.49-2.40), breast cancer-specific survival (HR, 2.04; 95% CI, 1.52-2.75), and overall survival (HR, 1.97; 95% CI, 1.51-2.59).Conclusions: In patients with primary breast cancer, the presence of CTCs was an independent predictor of poor disease-free, overall, breast cancer-specific, and distant disease-free survival. (C) 2016 AACR.