Circulating tumor cells in metastatic breast cancer: Biologic staging beyond tumor burden
Circulating tumor cells in metastatic breast cancer: Biologic staging beyond tumor burden
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DOI：
10.3816/cbc.2007.n.004
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发表时间：
2007-02-01
影响因子：
3.1
通讯作者：
Valero, Vicente
中科院分区：
文献类型：
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作者：
Cristofanilli, Massimo;Broglio, Kristine R.;Valero, Vicente
背景：循环肿瘤细胞（CTCs）的检测可以预测转移性乳腺癌（MBC）患者的总生存期。然而，与其他标准预后因素相比，ctc是否具有更高的价值尚不清楚。我们比较了ctc与临床和实验室测量的肿瘤负荷和疾病表型亚型的预后意义。患者和方法：在2000年至2006年期间对151例MBC患者进行回顾性分析。循环肿瘤细胞采用免疫磁头系统（CellSearch (TM) system）在全血中分离和枚举。根据CTCs水平（阴性：每7.5 mL血液中< 5个CTCs；阳性：>=每7.5 mL血液中5个CTCs）、Swenerton评分、癌症抗原27-29水平、年龄（< 50岁vs. >= 50岁）、激素受体状态和HER2状态、转移部位、治疗类型和线来评估总生存率。结果：患者的中位年龄为53岁（范围24-88岁），44%的患者患有bb50 ctc。阴性和阳性CTCs的中位总生存期分别为29.3个月和13.5个月（P < 0.0001）。在多变量Cox模型中，检测>= 5 CTCs的风险比最高，为死亡风险的2.2倍（P = 0.003）。预后价值与肿瘤负荷、治疗类型和治疗路线以及疾病的表型亚型无关。结论：循环肿瘤细胞对肿瘤负荷和疾病表型具有优越的独立预后价值，可能是MBC肿瘤生物学的重要标志物。在对MBC患者进行新的分期分层时应考虑ctc的检测。
Background: The detection of circulating tumor cells (CTCs) predicts overall survival in patients with metastatic breast cancer (MBC). However, it is unknown whether CTCs have superior value compared with other standard prognostic factors. We compared the prognostic significance of CTCs with clinical and laboratory measures of tumor burden and phenotypic subtype of disease. Patients and Methods: One hundred fifty-one patients with MBC evaluated between 2000 and 2006 were included in this retrospective analysis. Circulating tumor cells were isolated and enumerated in whole blood using an immunomagnetic bead system (CellSearch (TM) System). Overall survival was evaluated according to the level of CTCs (negative: < 5 CTCs per 7.5 mL of blood; positive: >= 5 CTCs per 7.5 mL of blood), Swenerton score, cancer antigen 27-29 level, age (< 50 years vs. >= 50 years), hormone-receptor status and HER2 status, metastatic site, and type and line of therapy. Results: The median age of patients was 53 years (range, 24-88 years), and 44% of the patients had > 5 CTCs. The median overall survival for negative versus positive CTCs were 29.3 months and 13.5 months, respectively (P < 0.0001). In the multivariable Cox model, the detection of >= 5 CTCs demonstrated the highest hazard ratio with 2.2 times the risk of death (P = 0.003). The prognostic value was independent of measure of tumor burden and type and line of therapy, and phenotypic subtype of the disease. Conclusion: Circulating tumor cells have superior and independent prognostic value of tumor burden and disease phenotype and might represent an important marker of tumor biology in MBC. Detection of CTCs should be considered for new staging stratification of patients with MBC.