Circulating tumor cells: A novel prognostic factor for newly diagnosed metastatic breast cancer
Circulating tumor cells: A novel prognostic factor for newly diagnosed metastatic breast cancer
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DOI：
10.1200/jco.2005.08.140
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发表时间：
2005-03-01
影响因子：
45.3
通讯作者：
Terstappen, LWMM
中科院分区：
文献类型：
--
作者：
Cristofanilli, M;Hayes, DF;Terstappen, LWMM
目的转移性乳腺癌（MBC）是无法治愈的；它的治疗是治标不治本的。我们研究了循环肿瘤细胞（CTCs）的存在是否能预测即将开始一线治疗的新诊断MBC患者的治疗疗效、无进展生存期（PFS）和总生存期（OS）。患者和方法177例可测量的MBC患者被纳入前瞻性研究。177例患者中有83例进入一线治疗，这些患者是本分析的重点。在治疗开始前（基线）和之后长达6个月每月抽取的7.5 mL全血中CTCs被分离并使用免疫磁学进行计数。结果平均（±标准差）随访时间为11.1±4.4个月（中位数为12.2个月）。43例（52%）患者在基线时ctc大于或等于5个。中位PFS为7.2个月（95% Cl， 4.9至9.4个月），中位OS超过18个月。基线和首次随访（4周）时CTCs大于或等于5个的患者预后差于CTCs小于5个的患者(基线：中位PFS，分别为4.9 v 9.5个月；log-rank, P = 0.0014；中位OS， 14.2 v > 18个月，分别为log-rank， P = 0.0048；首次随访：中位PFS，分别为2.1 v8.9个月；log-rank, P = 0.0070；中位OS，分别为11.1 v > 18个月；log-rank, P = .0029)，治疗开始前后的ctc是强有力的独立预后因素。结论在一线治疗开始前检测ctc可预测MBC患者的PFS和OS。这项技术可以帮助适当的患者分层和设计量身定制的治疗。(C) 2005年美国临床肿瘤学会。
Purpose Metastatic breast cancer (MBC) is incurable; its treatment is palliative. We investigated whether the presence of circulating tumor cells (CTCs) predicts treatment efficacy, progression-free survival (PFS), and overall survival (OS) in patients with newly diagnosed MBC who were about to start first-line therapy.Patients and Methods One hundred seventy-seven patients with measurable MBC were enrolled onto a prospective study. Eighty-three of the 177 patients were entering first-line treatment, and these patients are the focus of this analysis. CTCs from 7.5 mL of whole blood drawn before treatment initiation (baseline) and monthly thereafter for up to 6 months were isolated and enumerated using immunomagnetics.Results The mean (+/- standard deviation) follow-up time was 11.1 +/- 4.4 months (median, 12.2 months). Forty-three patients (52%) had greater than or equal to five CTCs at baseline. The median PFS was 7.2 months (95% Cl, 4.9 to 9.4 months), and the median OS was more than 18 months. Patients with greater than or equal to five CTCs at baseline and at first follow-up (4 weeks) had a worse prognosis than patients with less than five CTCs (baseline: median PFS, 4.9 v 9.5 months, respectively; log-rank, P = .0014; median OS, 14.2 v > 18 months, respectively log-rank, P = .0048; first follow-up: median PFS, 2.1 v8.9 months, respectively;, log-rank, P = .0070; median OS, 11.1 v > 18 months, respectively; log-rank, P = .0029), CTCs before and after the initiation of therapy were strong, independent prognostic factors.Conclusion Detection of CTCs before initiation of first-line therapy in patients with MBC is highly predictive of PFS and OS. This technology can aid in appropriate patient stratification and design of tailored treatments. (C) 2005 by American Society of Clinical Oncology.