Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: prognostic and predictive significance.
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In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53-6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48-6.0, p 0.002].In conclusion, CTCs are detected in one out of three patients with RM-HNC.The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor.
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PubMed Central - PubMed
Affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
ABSTRACT
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Introduction: We investigated the frequency of detection and the prognostic and predictive significance of circulating tumor cells (CTCs) in patients with recurrent/metastatic (R/M) head and neck carcinoma (HNC) before starting systemic therapy. Patients and methods: Using the CellSearch technology, CTCs were assessed prospectively in peripheral blood of 53 R/M-HNC patients. We performed spiking experiments to test the diagnostic performance of the CellSearch platform in identifying squamous carcinoma cells. Results: CTCs were identified in 14 (26%) and 22 (41%) patients at baseline and at any time point, respectively. In univariate analysis ≥2 CTCs had a poorer prognostic role than 0-1 CTC. In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53-6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48-6.0, p 0.002]. A disease control after systemic therapy was obtained in 8% of CTC-positive patients as opposed to 45% in CTC-negative ones (p 0.03). The epidermal growth factor receptor (EGFR) expression was identified in 45% of CTC-positive patients. Discussion: In conclusion, CTCs are detected in one out of three patients with RM-HNC. CTC detection is a strong prognostic parameter and may be predictive of treatment efficacy. The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor. Related in: MedlinePlus |
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pone-0103918-g002: Kaplan-Meier curves of (A) progression-free survival and (B) overall survival in patients with 0, 1 and ≥2 CTCs. Mentions: At the date of last follow-up (March 2012) all patients had progressed and died. In the overall population median PFS and OS from CTC analysis were 4 and 7 months, respectively. Median PFS in patients with 0, 1 and ≥2 CTCs at baseline were 5 months (95% CI 3.9–6.0), 5 months (95% CI 0.1–10.8) and 1 month (95% CI 0.8–1.6), respectively, (log-rank test p<.0005). Median OS in patients with 0, 1 and ≥2 CTCs at baseline were 9 months (95% CI 6.9–11.0), 7 months (95% CI 4.2–9.7) and 2 months (95% CI 0.1–4.1) respectively, (log-rank test p<.0005) (Figure 2A and 2B). These results indicate that ≥2 CTCs rather than 1 CTC might be a better cutoff indicator for both PFS and OS. |
View Article: PubMed Central - PubMed
Affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
Introduction: We investigated the frequency of detection and the prognostic and predictive significance of circulating tumor cells (CTCs) in patients with recurrent/metastatic (R/M) head and neck carcinoma (HNC) before starting systemic therapy.
Patients and methods: Using the CellSearch technology, CTCs were assessed prospectively in peripheral blood of 53 R/M-HNC patients. We performed spiking experiments to test the diagnostic performance of the CellSearch platform in identifying squamous carcinoma cells.
Results: CTCs were identified in 14 (26%) and 22 (41%) patients at baseline and at any time point, respectively. In univariate analysis ≥2 CTCs had a poorer prognostic role than 0-1 CTC. In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53-6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48-6.0, p 0.002]. A disease control after systemic therapy was obtained in 8% of CTC-positive patients as opposed to 45% in CTC-negative ones (p 0.03). The epidermal growth factor receptor (EGFR) expression was identified in 45% of CTC-positive patients.
Discussion: In conclusion, CTCs are detected in one out of three patients with RM-HNC. CTC detection is a strong prognostic parameter and may be predictive of treatment efficacy. The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor.