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

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 i...

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Detalles Bibliográficos
Autores principales: Rack, Brigitte, Schindlbeck, Christian, Jückstock, Julia, Andergassen, Ulrich, Hepp, Philip, Zwingers, Thomas, Friedl, Thomas W. P., Lorenz, Ralf, Tesch, Hans, Fasching, Peter A., Fehm, Tanja, Schneeweiss, Andreas, Lichtenegger, Werner, Beckmann, Matthias W., Friese, Klaus, Pantel, Klaus, Janni, Wolfgang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2014
Materias:
Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112925/
https://www.ncbi.nlm.nih.gov/pubmed/24832787
http://dx.doi.org/10.1093/jnci/dju066
Descripción
Sumario: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.

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