Clinical significance of circulating tumor cells in patients with locally advanced head and neck squamous cell carcinoma

Abstract

The present study aimed to investigate the clinical relevance of circulating tumor cells (CTCs) in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC), particularly in patients with nasopharyngeal and hypopharyngeal squamous cell carcinoma. CTCs were isolated using negative immunomagnetic bead enrichment and were identified by fluorescence in situ hybridization. Youden's index and the receiver operating characteristic (ROC) curve were used to select the optimal CTC baseline value. χ 2 test or Fisher's test were used to determine the association between CTC counts and clinical parameters, curative effects and prognosis. The Kaplan-Meier estimator was used to analyze overall survival (OS) and progression-free survival (PFS). In the present study, 356 peripheral blood samples (178 pretreatment samples and 178 post-treatment samples) from 178 patients were examined. The results revealed that the pretreatment CTC detection rate was 73.8%. The minimum, maximum and median CTC counts were 1, 22 and 2/3.2 ml, respectively. The number of polyploid CTCs was associated with distant metastasis (P=0.026). In addition, patients with undetectable CTCs, and decreasing or negative CTCs post-treatment tended to have a good prognosis (P<0.05). For nasopharyngeal squamous cell carcinoma, the PFS of patients with increased CTCs and CTCs ≥2/3.2 ml after treatment was significantly lower (P<0.05). For hypopharyngeal squamous cell carcinoma, it was suggested that CTCs with a cutoff value of 3 may be used to evaluate PFS and OS before and after treatment. In conclusion, CTCs may be used to monitor disease progression and the response to chemoradiotherapy for patients with LA-HNSCC. Furthermore, CTCs are a better predictor of the prognosis of hypopharyngeal squamous cell carcinoma than that of nasopharyngeal squamous cell carcinoma.

Circulating Tumor Cells: A Promising Biomarker in the Management of Nasopharyngeal Carcinoma

“…Cai et al (33) indicated that CTC-positive NPC patients had shorter OS and lower relapse-free survival rates than CTC-negative NPC patients. This result was consistent with the findings reported by Liu et al (27), in which patients with NPC with elevated CTC counts had significantly lower PFS than those with decreased or unchanged CTC counts after treatment. Si et al ( 28) also showed that decreased CTC counts after treatment suggested a favorable therapeutic effect in patients with NPC.…”

“…However, Zeng et al (26) found that the positive rate of CTCs was correlated with the N stage of NPC, and CTC-positive patients had a later N stage. Similarly, Liu et al (27) reported that the more advanced the clinical stage of patients with NPC, the higher the positive rate of CTCs. Si et al ( 28) also showed that there was a significant positive correlation between mesenchymal CTCs and the metastasis of NPC, especially lymph node metastasis.…”

Ex Vivo Expanded Circulating Tumor Cells for Clinical Anti-Cancer Drug Prediction in Patients with Head and Neck Cancer

“…To our knowledge, this is the first study to report the establishment of tumor organoids by using CTCs derived from peripheral blood liquid biopsies of HNC patients, as well as the first study to deploy CTC-derived organoids expanded ex vivo to assess drug sensitivity and correlate the results with an actual clinical response in HNC patients. CTCs are considered a key prognostic factor in HNC [ 46 , 47 ], and studies have shown that the detection of CTCs in peripheral blood [ 21 , 26 , 48 , 49 , 50 , 51 , 52 , 53 ], high CTC counts in peripheral blood [ 26 ], or increasing CTC counts over time [ 18 , 26 , 51 , 53 ] were associated with worse prognosis in patients with HNC. Although the US Food and Drug Administration (FDA) has approved the CellSearch system for use in clinical settings to detect and enumerate CTCs in peripheral blood [ 46 , 54 ], merely identifying the presence or number of CTCs does not provide sufficient information to guide treatment decisions.…”

Exploration of Feasible Immune Biomarkers for Immune Checkpoint Inhibitors in Head and Neck Squamous Cell Carcinoma Treatment in Real World Clinical Practice

“…In addition to CTCs, ctDNA is another material with 150-200 bp fragment DNA released from the tumor cells undergoing apoptosis or necrosis into the blood [111][112][113]. Compared with tissue biopsy, which remains the gold standard in the diagnosis of solid malignancies, analysis of CTCs or ctDNA are emerging as an important diagnostic tool because of it being time-saving, non-invasive, cheaper and there is lower risk of cancer spreading [113][114][115][116]. In HNSCC, investigation of CTCs and ctDNA in different disease or treatment status has been considered as a predictive marker for diagnosis, prognosis and response to treatment [55,109,110,114,[117][118][119].…”