Limits...
Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: prognostic and predictive significance.

Grisanti S, Almici C, Consoli F, Buglione M, Verardi R, Bolzoni-Villaret A, Bianchetti A, Ciccarese C, Mangoni M, Ferrari L, Biti G, Marini M, Ferrari VD, Nicolai P, Magrini SM, Berruti A - PLoS ONE (2014)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.

ABSTRACT

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.

Show MeSH

Related in: MedlinePlus

Example of CTCs analysis in a patient with mediastinal and axillary nodal metastases from an oropharyngeal squamous cell carcinoma.(A) the CellSearch output of baseline CTC analysis showing two CTCs with heterogeneous EGFR expression. (B) Timeline of CTC analysis and treatments. (C) Correlative imaging analysis by CT/PET at baseline and after chemotherapy. In this patient 3 CTCs were detected at baseline. After 4 cycles of a chemotherapy, CTC number rised to 9 suggesting progressive disease then confirmed by CT/PET imaging.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4126745&req=5

pone-0103918-g005: Example of CTCs analysis in a patient with mediastinal and axillary nodal metastases from an oropharyngeal squamous cell carcinoma.(A) the CellSearch output of baseline CTC analysis showing two CTCs with heterogeneous EGFR expression. (B) Timeline of CTC analysis and treatments. (C) Correlative imaging analysis by CT/PET at baseline and after chemotherapy. In this patient 3 CTCs were detected at baseline. After 4 cycles of a chemotherapy, CTC number rised to 9 suggesting progressive disease then confirmed by CT/PET imaging.

Mentions: Ten out of the 14 CTC-positive patients at baseline were tested before and after chemotherapy. Of them, five had a increase, one remained stable and four had a decrease of CTCs after treatment. By contrast, seven patients without CTCs at baseline had detectable CTCs at the end of treatment (Figure 4B). As an example, Figure 5 illustrates the outcome in terms of CTCs and imaging of a patient progressing after a line of chemotherapy. Changes in CTCs levels were not found to be correlated with tumor response.


Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: prognostic and predictive significance.

Grisanti S, Almici C, Consoli F, Buglione M, Verardi R, Bolzoni-Villaret A, Bianchetti A, Ciccarese C, Mangoni M, Ferrari L, Biti G, Marini M, Ferrari VD, Nicolai P, Magrini SM, Berruti A - PLoS ONE (2014)

Example of CTCs analysis in a patient with mediastinal and axillary nodal metastases from an oropharyngeal squamous cell carcinoma.(A) the CellSearch output of baseline CTC analysis showing two CTCs with heterogeneous EGFR expression. (B) Timeline of CTC analysis and treatments. (C) Correlative imaging analysis by CT/PET at baseline and after chemotherapy. In this patient 3 CTCs were detected at baseline. After 4 cycles of a chemotherapy, CTC number rised to 9 suggesting progressive disease then confirmed by CT/PET imaging.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126745&req=5

pone-0103918-g005: Example of CTCs analysis in a patient with mediastinal and axillary nodal metastases from an oropharyngeal squamous cell carcinoma.(A) the CellSearch output of baseline CTC analysis showing two CTCs with heterogeneous EGFR expression. (B) Timeline of CTC analysis and treatments. (C) Correlative imaging analysis by CT/PET at baseline and after chemotherapy. In this patient 3 CTCs were detected at baseline. After 4 cycles of a chemotherapy, CTC number rised to 9 suggesting progressive disease then confirmed by CT/PET imaging.
Mentions: Ten out of the 14 CTC-positive patients at baseline were tested before and after chemotherapy. Of them, five had a increase, one remained stable and four had a decrease of CTCs after treatment. By contrast, seven patients without CTCs at baseline had detectable CTCs at the end of treatment (Figure 4B). As an example, Figure 5 illustrates the outcome in terms of CTCs and imaging of a patient progressing after a line of chemotherapy. Changes in CTCs levels were not found to be correlated with tumor response.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus