Circulating Tumor Cells Predict Survival in Early Average-to-High Risk Breast Cancer Patients

By B. Rack, C. Schindlbeck, J. Jückstock, U. Andergassen, P. Hepp, T. Zwingers, Thomas W. P. Friedl, R. Lorenz, H. Tesch, Peter A. Fasching and 7 more. Journal of the National Cancer Institute, 2014

604 citations recorded by the source corpus.

Background Circulating tumor cells (CTCs) have been shown to predict reduced survival outcomes in metastatic breast cancer. Methods CTCs were analyzed in 2026 patients with early breast cancer before adjuvant chemotherapy and in 1492 patients after chemotherapy using the CellSearch System. After immuno-magnetic enrichment for cells expressing the epithelial-cell adhesion molecule, CTCs were defined as nucleated cells expressing cytokeratin and lacking CD45. The patients were followed for a median of 35 months (range = 0–54). Kaplan–Meier analyses and the log-rank test were used for survival analyses. All statistical tests were two-sided. Results Before chemotherapy, CTCs were detected in 21.5% of patients (n = 435 of 2026), with 19.6% (n = 136 of 692) of node-negative and 22.4% (n = 299 of 1334) of node-positive patients showing CTCs (P < .001). No association was found with tumor size, grading, or hormone receptor status. After chemotherapy, 22.1% of patients (n = 330 of 1493) were CTC positive. The presence of CTCs was associated with poor disease-free survival (DFS; P < .0001), distant DFS (P < .001), breast cancer-specific survival (P = .008), and overall survival (OS; P = .0002). CTCs were confirmed as independent prognostic markers in multivariable analysis for DFS (hazard ratio [HR] = 2.11; 95% confidence interval [CI] = 1.49 to 2.99; P < .0001) and OS (HR = 2.18; 95% CI = 1.32 to 3.59; P = .002). The prognosis was worst in patients with at least five CTCs per 30mL blood (DFS: HR = 4.51, 95% CI = 2.59 to 7.86; OS: HR = 3.60, 95% CI = 1.56 to 8.45). The presence of persisting CTCs after chemotherapy showed a negative influence on DFS (HR = 1.12; 95% CI = 1.02 to 1.25; P = .02) and on OS (HR = 1.16; 95% CI = 0.99 to 1.37; P = .06) Conclusions These results suggest the independent prognostic relevance of CTCs both before and after adjuvant chemotherapy in a large prospective trial of patients with primary breast cancer.

Subfields: Genetics, Oncology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/932baa0fc6d8ce7e0c2c573473b943bb1446d3ec

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

K. Seidi
Roghayyeh Baghban
Rana Jahanban-Esfahlan
M. Jaymand
Abbas Ebrahimi-Kalan
L. Roshangar
Tahereh Javaheri
Peyman Zare

Citations in the corpus

Tumor microenvironment complexity and therapeutic implications at a glance (2020, result): “piloted a larger prospective study with 2026 breast cancer patients and discovered that the detection rate of CTCs after chemotherapy (22.1%) increased slightly in comparison to the baseline condition (21.5%) [150] .”
RNA-Seq of Tumor-Educated Platelets Enables Blood-Based Pan-Cancer, Multiclass, and Molecular Pathway Cancer Diagnostics (2015, neutral): “…evaluated as liquid biopsies, including plasma DNA (Bettegowda et al., 2014; Chan et al., 2013; Diehl et al., 2008; Murtaza et al., 2013; Newman et al., 2014; Thierry et al., 2014) and circulating tumor cells (Bidard et al., 2014; Dawson et al., 2013; Maheswaran et al., 2008; Rack et al., 2014).”