Utility of Circulating Tumor Cells for Detection of Early-Stage Luminal A Breast Cancer

Abstract

Background: Patients with early-stage luminal A breast cancer (LABC) have better prognoses. However, follow-up examinations are frequent and remain complex. The present study examined whether circulating tumor cell (CTC) detection could be used as an earlier and more reproducible indicator of disease status among patients with early-stage LABC, and given China's healthcare resource challenges, whether it could periodically replace follow-up routine imaging. Methods: A total of 135 postoperative Chinese patients with early-stage LABC were randomly assigned to a CTC group (68 patients underwent alternating assessments using CTC detection and routine re-examination) or control group (67 patients underwent only routine re-examination). The prognosis and patient-covered costs of the various assessments were calculated for the 2 groups. Results: No patients had normal CTCs and simultaneous abnormal imaging findings. There were no differences in overall survival, disease-free survival and total patient-covered cost of follow-up between the 2 groups (all P > 0.05). However, there was a significant difference in the average patient-covered cost (P < 0.001). Furthermore, significant intergroup differences were observed in the total and average hospitalization times (P < 0.05). Conclusions: Among Chinese patients with low-risk LABC, CTC detection was highly reliable and relatively low cost. Therefore, CTC detection may be used to reduce the number of routine imaging follow-ups.

Circulating Tumour Cells in the Prediction of Bone Metastasis

“…CTC numbers were significantly higher in patients with bone metastases than in patients without bone metastases. It was also found that when bone metastases were present, 35% of patients had more than 21 CTCs and 61% had more than 5 CTCs; in patients without bone metastases, only 16% of patients had CTC counts greater than 5, showing a strong association between high CTC numbers and extensive skeletal involvement [30,32].…”

“…≥5 CTCs in 90% of patients with bone metastases Breast (2010) [30] Total CTCs associated with Time-to-Bone-Metastasis-Progression Breast (2021) [31] ≥1 CTCs in 93.65% of patients with bone metastasis Lung (2014) [32] Significant association between bone metastases and CTC expressing CXCR4 Neuroendocrine (2019) [33] CTC number ≥2 significantly associated with liver or bone metastases Lung (2011) [34] Diagnosis and prognosis of bone metastasis Prostate (2007) [35] CTC iChip Immunomagnetic 10 Role of androgen receptor signalling in CTCs in breast cancer bone metastasis Breast (2018) [36] RT-PCR Density gradient centrifugation 2.5 CTCs closely associated with clinical evidence of bone metastases Prostate (2009) [37] Currently, the CellSearch™ System is the only U.S. Food and Drug Administration approved method for the detection of CTCs in biological samples. The CellSearch™ system relies upon immunoaffinity to isolate CTCs which uses antibody binding to cell surface markers on CTCs.…”

“…The CellSearch™ system requires only a small amount of blood (7.5 mL) and therefore limits the clinical burden on patients. Using the CellSearch™ system (Cell Search, Huntington Valley, PA, USA), CTC counts have been used for the diagnosis and prognosis of bone metastasis in breast, lung, prostate and neuroendocrine cancer [30][31][32][33] and a significant association between the presence of CTCs and bone metastasis has been found in lung and neuroendocrine cancer [32,33]. There are, however, limitations of the CellSearch™ system, which include the high equipment costs and the CTCs themselves being highly variable in terms of cell surface markers expressed.…”

Utilization of Circulating Tumor Cells in the Management of Solid Tumors

“…Circulating tumor cells may play a role in disease surveillance. In a study of prostate cancer patients undergoing active surveillance, CTCs positivity was noted to be a marker of upstaging and upgrading, and therefore, positive CTCs may be an indication for treatment in patients with a localized malignancy [116]. Conversely, in a study using CTCs for screening following surgical resection of early-stage breast cancer, the use of CTCs for disease monitoring was not associated with improved OS or DFS [117].…”

Research progress of CTC, ctDNA, and EVs in cancer liquid biopsy

“…Furthermore, those experiencing acute myocardial infarction and heart failure have shown increased secretory microRNAs linked to cardiovascular ailments. MicroRNAs such as miR-499, miR-133, miR-208, miR-192, miR-194, and miR-34a ( 86 – 88 , 187 ) belong to this group. There is great potential for the clinical identification of disorders of the central nervous system based on the unique expression patterns of miR-21, miR-29, miR-219, LRP6, REST1, and caveolin1 in exosomes ( 89 – 92 ).…”