Abstract
To investigate whether circulating tumor cells (CTCs) are detectable in patients with gestational choriocarcinoma (GC) and evaluate the prognostic value of CTC enumeration. In this multicenter study, the presence of CTCs was examined in 180 GC patients using a semi-automated NanoVelcro system, among whom 106 patients underwent CTC re-evaluation after one cycle of chemotherapy. Approximately 96% of the GC patients contained ≥2 CTCs in 7.5 mL of blood. The number of CTCs per 7.5 mL of blood was much higher in patients with distant metastases (n = 95; range, 0 to 104) than in patients without distant metastases (n = 85; range, 0 to 6). Applying a 90-patient training and 90-patient validation cohort, a cutoff value of ≥6 CTCs was defined as the prognostic threshold for progression-free survival (PFS) and overall survival (OS). The presence of ≥6 CTCs was significantly associated with worse PFS and OS (both P < 0.001). A multivariate analysis showed that the CTC number (≥6 CTCs) was the strongest predictor of OS (hazard ratio [HR], 15.8; 95% confidence interval [CI], 4.3-57.9; P < 0.001). The number of CTCs decreased after one cycle of chemotherapy; univariate analyses demonstrated that the CTC count after the first chemotherapy cycle was a strong predictor of OS (HR, 36.1; 95% CI, 4.8-271.5; P < 0.001). CTCs are a promising prognostic factor for GC. The absolute CTC count after one cycle of chemotherapy in the context of this disease is a strong predictor of chemotherapy response.
Highlights
Gestational choriocarcinoma (GC), a type of aggressive and malignant gestational trophoblastic neoplasia, occurs in approximately 1 in 20 000 to 40 000 any form of previous conceptions.[1]
Our preliminary experiment shows that EpCAM and CD147 staining was mainly detected on the cell membrane (Fig. 2A)
All GC cells exhibited negative staining for CD45, the white cell specific marker (Fig. 2A). These were consistent with other research studies,[13,14] and EpCAM and CD147 were recognized as suitable markers for circulating tumor cell (CTC) detection and enumeration[15,16] (Fig. 1)
Summary
Gestational choriocarcinoma (GC), a type of aggressive and malignant gestational trophoblastic neoplasia, occurs in approximately 1 in 20 000 to 40 000 any form of previous conceptions.[1] Due to the efficiency of chemotherapy and the dynamic monitoring management based on beta human chorionic gonadotropin (β-HCG), the majority of GC cases are usually curable.[2,3] critical clinical information such as comprehensive metastasis status and resistance to conventional chemotherapy manifested in some cases cannot be fully revealed and assessed only by the β-HCG level. High level β-HCG does not reflect the risk of disease and the prognosis in parallel.[5] further exploration on effective clinical indicators to assist disease-status and chemotherapy response evaluation is of great significance to guide the clinical management of GC
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