Circulating Tumor Cell Number as a Prognostic Marker in Progressive Castration-Resistant Prostate Cancer: Use in Clinical Practice and Clinical Trials
By H. Scher, X. Jia, J. D. de Bono, M. Fleisher, K. Pienta, D. Raghavan, G. Heller. The Lancet Oncology, 2009
598 citations recorded by the source corpus.
SUMMARY Background To assess the use of circulating tumor cell (CTC) number as a continuous variable as a prognostic factor for survival, and for the clinical management of patients with progressive metastatic castration-resistant prostate cancer receiving first-line chemotherapy. Methods The study included 164 men with progressive metastatic castration-resistant prostate cancer. CTCs were isolated by immunomagnetic capture from blood samples drawn at baseline and after the initiation of first-line chemotherapy. Baseline variables including CTC number, prostate-specific antigen (PSA), and lactate dehydrogenase (LDH), and posttreatment variables (fold change in CTCs and PSA) were tested for association with survival using the Cox proportional hazards models. The concordance probability estimate was used to gauge the discriminatory strength of the informative factors in separating low- and high-risk patients. Findings At baseline, variables associated with increased risk of death were a high LDH (hazard ratio [HR] 6.44), CTC number (HR 1.58), and PSA (HR 1.26), low albumin (HR 0.10), and low hemoglobin (HR 0.72) (all p<0.001). At 4, 8, and 12 weeks posttreatment, changes in CTC number were strongly associated with risk (all p≤0.001), while changes in PSA were modestly associated (p=0.04 to 0.8). The combination of factors most predictive of survival were LDH and CTC number (concordance probability estimate 0.72–0.75). Time to CTC progression was modestly associated with time to death. Interpretation CTC number, analyzed as a continuous variable, was more predictive of survival than PSA at baseline and during patient follow-up, and can be used to monitor disease status. A model including baseline and posttreatment CTC, independent of discrete cutoff values, and baseline LDH was most predictive. The prospective evaluation of CTC number as an intermediate endpoint of survival in randomized prospective clinical trials is warranted. Funding The Prostate Cancer Foundation.
Subfields: Oncology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/d56e3a3c9530bbf5c01795cd784355f03051beac
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Oncology
Citations in the corpus
- Circulating tumor cells: approaches to isolation and characterization (2011, unknown): “, pretreatment) CTC numbers among different cancer patients are not well correlated with standard measures of tumor mass, including tumor size determined radiographically by x ray or CT (computed tomography) scan or serum protein markers, such as PSA levels in prostate cancer (Budd et al., 2006; Sch”
- Significance of Circulating Tumor Cells Detected by the CellSearch System in Patients with Metastatic Breast Colorectal and Prostate Cancer (2009, methodology): “Ideally, these modalities would be noninvasive, be independent of treatment, and provide quantitative real-time analysis of tumor activity in a variety of carcinomas.”
- Genetics and biology of prostate cancer (2018, background): “…al. 2007, 2011; de Bono et al. 2008; Scher et al. 2009; Goldkorn et al. 2014; Scher et al. 2015) and changes in posttreatment CTC count (Olmos et al. 2009; Scher et al. 2009; Goldkorn et al. 2014) were found to be prognostic factors for overall survival in prostate cancer patients with metastasis.”