Role of Circulating Tumor Cells in Determining Prognosis in Metastatic Breast Cancer

Abstract

Background Circulating tumor cells (CTCs) in the peripheral blood may play a major role in the metastatic spread of breast cancer. This study was conducted to assess the role of CTCs to determine the prognosis in terms of survival in metastatic breast cancer patients. Methods This prospective study of 36 patients was conducted at the Hospital from April 2016 to May 2018. Details of each patient related to the demographic profile, tumor type, treatment, and follow-up information were recorded. The number of CTCs in the peripheral blood was measured by Celsee PREP 400 sample processing system and Celsee Analyzer imaging station. Results There was a positive correlation between the number of site of metastasis with number of CTCs (p-value < 0.001). In the patients with clinical/partial response, a significant reduction in the number of CTCs after 1 month of therapy was observed (p-value = 0.003). When the number of CTCs at baseline and 6 months were compared with the positron emission tomography response at 6 months, a statistically significant difference in CTCs in patients having partial response after 6 months was observed (p-value = 0.001). On comparison with the responder groups, a statistically significant reduction in CTCs at baseline and 6 months was observed (p-value = 0.001). Patients with CTCs less than 5 and more than or equal to 5 after 1 month of treatment had a mean progression-free survival of 11.1 months and 7.5 months (p-value = 0.04) and a mean overall survival of 11.6 and 9.6 months (p-value = 0.08), respectively. Conclusion Assessment of CTCs provides a more quantifiable response than radiographic evaluation and at a much earlier time point and is also a better predictor of survival.

Exploring the Immunological Profile in Breast Cancer: Recent Advances in Diagnosis and Prognosis through Circulating Tumor Cells

“…Recent survey data indicate that the incidence and mortality rates of BC have remained elevated in recent years [16,17]. Distant metastasis is identified as a significant contributor to mortality among BC patients [4]. Research findings indicate that 20-30% of individuals diagnosed with BC may experience metastasis post the diagnosis and treatment of the primary tumor, with approximately 90% of cancer-related fatalities attributed to metastatic progression [18].…”

“…Reportedly, micrometastases and macrometastasis are formed by around 2.5% and 0.01% of CTCs, respectively [4]. The utilization of multiple sampling in detecting CTCs offers a real-time "liquid biopsy", significantly aiding in treatment selection and optimization [26].…”

“…The presence of CTCs in peripheral blood has been correlated with early metastatic relapse in BC, serving as predictors for progression-free survival (PFS) and overall survival (OS) [29]. Enumeration and analysis of CTCs play a crucial role in distinguishing between high-and low-risk profiles for PFS and OS [4].…”

“…It continues to assert its prominence as the most frequently diagnosed cancer worldwide, constituting a staggering 23% of all cancer cases and contributing to 14% of cancer-related deaths [3]. The gravity of this malignancy is underscored by its recent ascendancy over lung cancer in 2020, solidifying its status as the most prevalent type of cancer across the globe [4,5]. BC is commonly categorized into four subtypes based on molecular characteristics and hormone receptor (HR) expression on immunohistochemistry (IHC): Human epidermal growth factor receptor 2 (HER2)-overexpression subtype (15-20% of BCs, ER+, PR+), Luminal A subtype (40-60% of BCs, ER+, PR+, Ki67 < 20%), Luminal B subtype (10-20% of BCs, ER+, PR+ or PR−, HER2+ or HER2−, Ki67 > 20%), and Triple-negative BC (TNBC)/basal-like subtype.…”

Navigating Breast Cancer Oligometastasis and Oligoprogression: Current Landscape and Future Directions

“…These potential biomarkers include circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA). Detectable CTCs had a positive correlation with the number of metastatic lesions reported in a small prospective study ( p <0.001) [ 140 ]. In this study, there were also significant correlations with the number of CTCs and partial response on PET/CT observed 1 and 6 months after treatment.…”