Abstract
Objective To explore the application value of circulating tumor cells (CTCs) and circulating free DNA (cfDNA) from peripheral blood in the prognosis of advanced gastric cancer (AGC). Here, we measured CTCs and cfDNA quantity for predicting the outcome of patients. Patients and Methods. Forty-five patients with advanced gastric cancer who underwent neoadjuvant chemotherapy and surgical treatment were enrolled in this study. All patients received neoadjuvant chemotherapy with paclitaxel + S-1 + oxaliplatin (PSOX) regimen, and CTCs and cfDNA of the peripheral blood were detected before and after neoadjuvant therapy. Relationships between the number/type of CTC or cfDNA and the efficacy of neoadjuvant chemotherapy were analyzed. Results Among 45 patients, 43 (95.6%) were positive, and the positive rate of mesenchymal CTC was increased with the increase in the T stage. The proportion of mesenchymal CTC was positively correlated with the N stage (P < 0.05), and the larger N stage will have the higher proportion of mesenchymal CTC. Patients with a small number of mesenchymal CTC before neoadjuvant chemotherapy were more likely to achieve partial response (PR) with neoadjuvant therapy. Patients with positive CA-199 were more likely to achieve PR with neoadjuvant therapy (P < 0.05). Patients in the PR group were more likely to have decreased/unchanged cfDNA concentration after neoadjuvant therapy (P=0.119). After neoadjuvant therapy (before surgery), the cfDNA concentration was higher and the efficacy of neoadjuvant therapy (SD or PD) was lower (P=0.045). Conclusions Peripheral blood CTC, especially interstitial CTC and cfDNA, has a certain value in predicting the efficacy and prognosis of neoadjuvant chemotherapy in advanced gastric cancer.
Highlights
Gastric cancer (GC) is one of the most common malignant tumors of the digestive tract according to World Health Organization (WHO) data [1]
Enrollment criteria were as follows: (1) a total of 45 cases were diagnosed with gastric cancer by endoscopy and tumor tissues by biopsy; (2) TNM staging of all patients was T34N × M0; (3) physical status score of eastern cooperative oncology group (ECOG) ≤2 points and could tolerate chemotherapy; (4) newly diagnosed patients with no previous radical or palliative surgery, radiotherapy, and chemotherapy history; (5) the functions of liver and kidney were in the normal range; and (6) age was between 18 and 80 years old
Neoadjuvant therapy efficacy was as follows: there were 27 patients with neoadjuvant efficacy evaluation results, with 10 partial response (PR), 16 stable diseases (SDs), and 1 progressive disease (PD); circulating tumor cells (CTCs) statistical definition was as follows: when counting the positive rate of mesenchymal CTCs, if we set up mesenchymal CTC 0, it was negative and if the mesenchymal CTC ≥ 1, it was positive
Summary
Gastric cancer (GC) is one of the most common malignant tumors of the digestive tract according to World Health Organization (WHO) data [1]. Gastric cancer in China has a high mortality rate and is up to 20/100,000 [3]. Most case belong to advanced gastric cancer (AGC) based on standard tumor-node-metastasis (TNM) staging [4] when they were diagnosed in China. Surgery of no doubt is the best treatment tool for those who were classified as highly differentiated GC. The number of AGC patients for surgery was limited because of their staging. Many studies suggested that patients with cancer can perform preoperative or perioperative neoadjuvant chemotherapy for shrinking tumor size or killing micrometastases [5,6,7]. Erefore, the key for the treatment of the patients with GC is to identify sensitivity and specificity markers at their early stage.
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