Thalgott M, Heck M M, Eiber M, Souvatzoglou M, Hatzichristodoulou G, Kehl V, Krause B J, Rack B, Retz M, Gschwend J E, Andergassen U, Nawroth R
Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
J Cancer Res Clin Oncol. 2015 Aug;141(8):1457-64. doi: 10.1007/s00432-015-1936-z. Epub 2015 Feb 24.
Circulating tumor cell (CTC) counts might display a superior prognostic value for overall survival (OS) compared to objective response criteria (OR) in metastatic castration-resistant prostate cancer (mCRPC) patients.
CTCs were detected using the CellSearch™ System out of 122 samples during docetaxel chemotherapy (75 mg/m(2)) at baseline (q0) and after 1 (q1), 4 (q4) and 10 (q10) cycles, in mCRPC patients (n = 33). OR was evaluated by morphologic RECIST and clinical criteria after 4 (q4) and 10 (q10) cycles.
For OS, analyses revealed a significant prognostic value for categorical (<5 vs. ≥5) CTC counts (q0, p = 0.005; q1, p = 0.001; q4, p < 0.001; q10, p = 0.002), RECIST (q4, p < 0.001; q10, p = 0.02) and clinical criteria (q4, p < 0.001; q10, p = 0.02). Concordance of CTC counts with OR revealed a sensitivity of 83.3-87.5 % and a specificity of 68.0-76.5 % with complementary discriminatory power for OS. Comparing CTC counts with concomitant OR at q4 in multivariate analyses, an independent prognostic value for OS was found for CTC counts (HR 3.3; p = 0.02) similar to clinical (HR 4.9; p = 0.02) and radiologic response (HR 3.4; p = 0.051). Comparing the predictive value for death, early post-treatment CTC counts at q1 demonstrated significant accuracy with an area under the curve of 79.5 % (p = 0.004) similar to CTC counts at q4 (76.7 %; p = 0.009). Radiologic and clinical response at q4 displayed accuracy similar to early CTC counts at q1 (72.2 %; p = 0.03 and 75.0 %; p = 0.02) despite low sensitivities.
CTC counts appear to be an earlier and more sensitive predictor for survival and treatment response than current OR approaches and may provide complementary information toward individualized treatment strategies.
与客观缓解标准（OR）相比，循环肿瘤细胞（CTC）计数对转移性去势抵抗性前列腺癌（mCRPC）患者的总生存期（OS）可能具有更高的预后价值。
在33例mCRPC患者中，于多西他赛化疗（75mg/m²）基线期（q0）以及第1（q1）、4（q4）和10（q10）周期后，使用CellSearch™系统从122份样本中检测CTC。在第4（q4）和10（q10）周期后，通过形态学RECIST和临床标准评估OR。
对于OS，分析显示分类（<5 vs.≥5）CTC计数（q0，p = 0.005；q1，p = 0.001；q4，p < 0.001；q10，p = 0.002）、RECIST（q4，p < 0.001；q10，p = 0.02）和临床标准（q4，p < 0.001；q10，p = 0.02）具有显著的预后价值。CTC计数与OR的一致性显示，其对OS的敏感性为83.3 - 87.5%，特异性为68.0 - 76.5%，具有互补的判别能力。在多变量分析中比较q4时的CTC计数与同期OR，发现CTC计数对OS具有独立的预后价值（HR 3.3；p = 0.02），与临床（HR 4.9；p = 0.02）和放射学缓解（HR 3.4；p = 0.051）相似。比较死亡预测值，q1时治疗后早期CTC计数的曲线下面积为79.5%（p = 0.004），显示出显著的准确性，与q4时的CTC计数（76.７%；p = 0.009）相似。尽管敏感性较低，但q4时的放射学和临床缓解显示出与q1时早期CTC计数相似的准确性（72.2%；p = 0.03和75.0%；p = 0.02）。
与当前的OR方法相比，CTC计数似乎是生存和治疗反应的更早且更敏感的预测指标，可能为个体化治疗策略提供补充信息。
