Abstract
BackgroundSurgery is the treatment of choice for patients with non-small cell lung cancer (NSCLC) stages I-IIIA. However, more than 20% of these patients develop recurrence and die due to their disease. The release of tumor cells into peripheral blood (CTCs) is one of the main causes of recurrence of cancer. The objectives of this study are to identify the prognostic value of the presence and characterization of CTCs in peripheral blood in patients undergoing radical resection for NSCLC.Patients and Methods56 patients who underwent radical surgery for previously untreated NSCLC were enrolled in this prospective study. Peripheral blood samples for CTC analysis were obtained before and one month after surgery. In addition CTCs were phenotypically characterized by epidermal growth factor receptor (EGFR) expression.Results51.8% of the patients evaluated were positive with the presence of CTCs at baseline. A decrease in the detection rate of CTCs was observed in these patients one month after surgery (32.1%) (p = 0.035). The mean number of CTCs was 3.16 per 10 ml (range 0–84) preoperatively and 0.66 (range 0–3) in postoperative determination. EGFR expression was found in 89.7% of the patients at baseline and in 38.9% patients one month after surgery. The presence of CTCs after surgery was significantly associated with early recurrence (p = 0.018) and a shorter disease free survival (DFS) (p = .008). In multivariate analysis CTC presence after surgery (HR = 5.750, 95% CI: 1.50–21.946, p = 0.010) and N status (HR = 0.296, 95% CI: 0.091–0.961, p = 0.043) were independent prognostic factors for DFS.ConclusionCTCs can be detected and characterized in patients undergoing radical resection for non-small cell lung cancer. Their presence might be used to identify patients with increased risk of early recurrence.
Highlights
Lung cancer represents the leading cause of cancer related death for both men and women, and even in early stages outcomes remain poor [1]
This group of patients with worse than expected prognosis makes it necessary to improve risk stratification with more sensitive prognostic factors. These new prognostic factors must be the result of a better understanding of metastatic process, intimately linked with the detection of CTCs. In this regard increasing evidence suggests that early relapse in resected non-small cell lung cancer (NSCLC) patients may arise from circulating tumor cells (CTCs) that shed from the primary tumor into the vascular system since the beginning of the malignant process
CTCs were detected in peripheral blood of 51.8% of patients at baseline (CTC1) (29 of 56 patients) Interestingly, we observed that the detection rate of CTCs in these patients was significantly lower one month after surgery (CTC2) (18 patients, 32.1%) p = 0.034, yielded from the Wilcoxon signed-rank test
Summary
Lung cancer represents the leading cause of cancer related death for both men and women, and even in early stages outcomes remain poor [1]. Despite optimal surgical treatment more than 20% of patients designated as early stages by conventional criteria will recur and eventually die of recurrent non-small cell lung cancer (NSCLC) [2,3] This group of patients with worse than expected prognosis makes it necessary to improve risk stratification with more sensitive prognostic factors. These new prognostic factors must be the result of a better understanding of metastatic process, intimately linked with the detection of CTCs. These new prognostic factors must be the result of a better understanding of metastatic process, intimately linked with the detection of CTCs In this regard increasing evidence suggests that early relapse in resected NSCLC patients may arise from circulating tumor cells (CTCs) that shed from the primary tumor into the vascular system since the beginning of the malignant process.
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