Department of Breast Surgical Oncology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Breast Cancer. 2012 Apr;19(2):110-7. doi: 10.1007/s12282-011-0282-5. Epub 2011 Jun 4.
Metastasis remains a main cause of death in patients with breast cancer regardless of improvements in treatment. Prospective clinical studies of this minimal residual disease have shown disseminated tumor cells (DTCs) in bone marrow and circulating tumor cells (CTCs) in peripheral blood, neither of which can be detected by conventional imaging, to be prognostic and predictive markers for responsive treatment in patients with metastatic breast cancer. However, the guideline from the American Society of Clinical Oncology does not recommend measuring CTCs for clinical decisions because of a lack of evidence for an established, sound methodology and with proven clinical relevance. The Southwest Oncology Group trial S0500 to validate the clinical relevance of CTCs for treatment decisions in patients with metastatic breast cancer is ongoing. In patients with primary breast cancer, the low detection rate of CTCs has been overcome by recent advances in technology. Although generally DTCs were more detectable than CTCs and the association between presence of DTCs and poor prognosis has been shown, the invasiveness of sample collection of DTCs from bone marrow is generally hard for patients to accept. In this review, we concentrate on the question of whether we need to consider CTCs and DTCs in the management of primary breast cancer on the basis of the evidence of the clinical relevance of CTCs and DTCs. The promising role of the molecular characterization of CTCs, which does have the potential for being a predictor for tumor behavior and development, is suggested as a new targeting strategy.
转移仍然是乳腺癌患者死亡的主要原因，无论治疗有何改善。对这种微小残留疾病的前瞻性临床研究表明，骨髓中的播散性肿瘤细胞（DTC）和外周血中的循环肿瘤细胞（CTC）都不能被常规成像检测到，它们是转移性乳腺癌患者对治疗有反应的预后和预测标志物。然而，由于缺乏既定、可靠方法的证据以及已证明的临床相关性，美国临床肿瘤学会的指南不建议测量 CTC 用于临床决策。西南肿瘤组试验 S0500 正在进行中，以验证 CTC 对转移性乳腺癌患者治疗决策的临床相关性。在原发性乳腺癌患者中，CTC 的低检测率已被最近技术的进步所克服。尽管一般来说 DTC 比 CTC 更易检测，并且已经表明 DTC 的存在与预后不良之间存在关联，但从骨髓中采集 DTC 的样本采集的侵袭性通常让患者难以接受。在这篇综述中，我们根据 CTC 和 DTC 的临床相关性证据，集中讨论在原发性乳腺癌的管理中是否需要考虑 CTC 和 DTC 的问题。建议将 CTC 的分子特征作为一种新的靶向策略，因为它具有预测肿瘤行为和发展的潜力。
