Department of Medical Oncology, University Hospital of Heraklion, PO Box 1352, 711 10 Heraklion, Crete, Greece.
Br J Cancer. 2013 Feb 19;108(3):549-56. doi: 10.1038/bjc.2012.597. Epub 2013 Jan 17.
To determine the effect of adjuvant taxane-free and taxane-based chemotherapy regimens on the elimination of circulating tumour cells (CTCs) in patients with early breast cancer.
The presence of CK-19 mRNA-positive CTCs in the peripheral blood was evaluated before and after chemotherapy, using a real-time RT-PCR assay, in a historical comparison of two cohorts of women with stage I-III breast cancer treated with adjuvant taxane-free (N=211; FE(75)C or E(75)C) and taxane-based (N=334; T/E(75)C or T/E(75)) chemotherapy.
Taxane-based chemotherapy resulted in a higher incidence of CTCs' elimination than taxane-free regimens since 49.7% (74 of 149) and 33.0% (29 of 88) of patients with detectable CTCs before chemotherapy, respectively, turned negative post-chemotherapy (P=0.015). Patients treated with taxane-free regimens had a significantly lower disease-free survival (DFS) (P=0.035) than patients treated with taxane-based regimens; this difference was observed in patients with but not without detectable CTCs before chemotherapy (P=0.018 and P=0.481, respectively). The incidence of deaths was significantly higher in the taxane-free cohort of patients with but not without detectable CTCs before chemotherapy compared with that of the taxane-based cohort (P=0.002). Multivariate analysis revealed that the chemotherapy regimen was significantly associated with prolonged DFS (HR: 2.00; 95% CI=1.20-3.34).
Elimination of CK-19 mRNA-positive CTCs during adjuvant chemotherapy seems to be an efficacy indicator of treatment and is associated with a favourable clinical outcome of patients with detectable CTCs before chemotherapy.
为了确定辅助紫杉烷-free 和紫杉烷为基础的化疗方案对循环肿瘤细胞 (CTC) 的消除早期乳腺癌患者的影响。
采用实时 RT-PCR 检测方法，在接受辅助紫杉烷-free (FE(75)C 或 E(75)C，n=211) 和紫杉烷为基础 (T/E(75)C 或 T/E(75)，n=334) 化疗的 I-III 期乳腺癌患者的两个队列的历史比较中，评估化疗前后外周血中 CK-19mRNA 阳性 CTC 的存在。
与紫杉烷-free 方案相比，紫杉烷为基础的化疗方案导致 CTC 消除的发生率更高，因为分别有 49.7%（化疗前可检测到 CTC 的 149 例患者中的 74 例）和 33.0%（化疗前可检测到 CTC 的 88 例患者中的 29 例）在化疗后转为阴性（P=0.015）。接受紫杉烷-free 方案治疗的患者无病生存（DFS）显著低于接受紫杉烷为基础方案治疗的患者（P=0.035）；这种差异在化疗前可检测到 CTC 的患者中观察到（P=0.018 和 P=0.481），而在化疗前不可检测到 CTC 的患者中未观察到（P=0.481）。与接受紫杉烷为基础方案治疗的患者相比，化疗前可检测到 CTC 的紫杉烷-free 方案治疗的患者中死亡的发生率显著更高（P=0.002）。多变量分析显示，化疗方案与延长 DFS 显著相关（HR：2.00；95%CI=1.20-3.34）。
辅助化疗期间 CK-19mRNA 阳性 CTC 的消除似乎是治疗效果的指标，与化疗前可检测到 CTC 的患者的良好临床结局相关。
