Bünger S, Zimmermann M, Habermann J K
Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Cancer Metastasis Rev. 2015 Sep;34(3):527-45. doi: 10.1007/s10555-015-9582-0.
Hematogenous spreading of tumor cells from primary tumors is a crucial step in the cascade to metastasis, the latter being the most limiting factor for patients' survival prognosis. Therefore, circulating tumor cells (CTCs) have become a field of intensive research. However, the process of isolation and identification of CTCs lacks standardization. This article presents an overview of 71 CTC studies reported in PUBMED since 2000 and focusing on colorectal cancer. These studies are evaluated regarding standardization of CTC isolation and identification, marker proteins used, study population and blood sample quality management, clinical performance, and quality measures. Overall, standardization of CTC assessment seems insufficient. Thus, comparability of CTC studies is hampered and results should be interpreted carefully. We here propose a standardized CTC guideline (CTC Guide) to prospectively design and report studies/trials in a harmonized form. Despite the current interstudy heterogeneity, the data indicate that CTC detection is of clinical relevance and CTCs should be considered as a surrogate prognostic marker. Many studies indicate the high potential for CTCs as prognostic markers, e.g., in colorectal cancer treatment. However, standardized, large-scale multicenter validation studies are still needed to pave the way for clinical implementation of CTC detection that could ameliorate individualized medicine regimes.
肿瘤细胞从原发肿瘤发生血行播散是转移级联反应中的关键步骤，而转移是影响患者生存预后的最主要限制因素。因此，循环肿瘤细胞（CTC）已成为一个深入研究的领域。然而，CTC的分离和鉴定过程缺乏标准化。本文概述了自2000年以来发表在PUBMED上的71项关于CTC的研究，这些研究聚焦于结直肠癌。对这些研究在CTC分离和鉴定的标准化、所用标记蛋白、研究人群和血样质量管理、临床性能以及质量控制措施等方面进行了评估。总体而言，CTC评估的标准化似乎不足。因此，CTC研究的可比性受到影响，对结果的解读应谨慎。我们在此提出一项标准化的CTC指南（CTC Guide），以便以前瞻性的方式统一设计和报告研究/试验。尽管目前研究间存在异质性，但数据表明CTC检测具有临床相关性，CTC应被视为一种替代预后标志物。许多研究表明CTC作为预后标志物具有很大潜力，例如在结直肠癌治疗中。然而，仍需要标准化的大规模多中心验证研究，为能够改善个体化医疗方案的CTC检测临床应用铺平道路。
