Circulating Tumor Cells Identify Early Recurrence in Patients with Non-Small Cell Lung Cancer Undergoing Radical Resection

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.

Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review

“…Furthermore, liquid biopsy, e.g., CTC detection has been introduced and a few pilot studies regarding early diagnosis of lung cancer have been published [47–65]. According to application in specific location and situation, we systemic reviewed clinical updates of these approaches focusing on development trends, detection rate and complications .…”

Liquid biopsy based biomarkers in non-small cell lung cancer for diagnosis and treatment monitoring

“…In particular, the decrease or disappearance of CTCs following surgery has been correlated with improved clinical outcomes (28,29). A recent study (30) has prospectively analysed the kinetics of CTCs in blood samples of 56 patients obtained before surgery and one month after. The results showed that the presence of CTCs after surgery was significantly associated with early recurrence (P=0.018) and a shorter disease-free survival (DFS) (P=0.008).…”

Liquid Biopsy in Non-Small Cell Lung Cancer

“…In early-stage patients, the decrease or disappearance of CTCs after surgery has been reported to correlate with better clinical outcomes (98, 99), while its persistence was associated with shorter progression-free survival (PFS) (100). Regarding advanced NSCLC, some studies have reported that a higher CTC count at presentation correlates with advanced stage and shorter PFS and overall survival (85, 101).…”