Pernot Simon, Badoual Cecile, Terme Magali, Castan Florence, Cazes Aurelie, Bouche Olivier, Bennouna Jaafar, Francois Eric, Ghiringhelli Francois, De La Fouchardiere Christelle, Samalin Emmanuelle, Bachet Jean Baptiste, Borg Christophe, Ducreux Michel, Marcheteau Elie, Stanbury Trevor, Gourgou Sophie, Malka David, Taieb Julien
INSERM U970 - PARCC (Paris Cardiovascular Research Center), Paris Descartes University, Sorbonne Paris Cité, Paris, France; Hôpital Européen Georges-Pompidou, APHP, Department of GI Oncology, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
INSERM U970 - PARCC (Paris Cardiovascular Research Center), Paris Descartes University, Sorbonne Paris Cité, Paris, France; Hôpital Européen Georges-Pompidou, APHP, Department of Pathology, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Eur J Cancer. 2017 Jul;79:15-22. doi: 10.1016/j.ejca.2017.03.036. Epub 2017 Apr 26.
The identification of dynamic biomarkers in advanced gastric and oesogastric junction adenocarcinoma (GOA) could help to tailor strategies for each patient. Enumeration of circulating tumour cells (CTCs) is approved by the US Food and Drug Administration in breast, colon and prostate cancer but is not in advanced GOA. Our study aims to establish the optimal threshold and the clinical significance of CTC count in advanced GOA before and during treatment.
One hundred six patients with untreated advanced GOA were included in the ancillary study of the PRODIGE 17-ACCORD 20 trial. CTCs were detected in the peripheral blood using the CellSearch system on day 0 (D0) and day 28 (D28). The prognostic value of CTCs at D0 and D28 was analysed by testing several thresholds.
At baseline, median CTC count was 1 (range, 0-415). While CTCs ≥1, 2 or 3 at D0 were all significantly associated with worse overall survival (OS) and progression-free survival (PFS), CTCs ≥2 were the optimal threshold, on D0 or D28. CTCs ≥2 at D28 were also predictive of disease control. Taking into account both D0 and D28 CTC count defined 3 groups (low/low, high/low and low-high/high) with significantly different PFS (p = 0.0002) and OS (p = 0.003).
Quantification of CTCs at baseline and during treatment may be a useful prognostic tool in advanced GOA, as it is associated with worse PFS and OS. A threshold ≥2 CTCs seems to have the best discriminant value. Change in CTC count between baseline and D28 could help to tailor treatment to each individual patient.
鉴定晚期胃癌和胃食管交界腺癌（GOA）的动态生物标志物有助于为每位患者量身定制治疗策略。循环肿瘤细胞（CTC）计数已获美国食品药品监督管理局批准用于乳腺癌、结肠癌和前列腺癌，但尚未用于晚期GOA。我们的研究旨在确定晚期GOA治疗前及治疗期间CTC计数的最佳阈值及其临床意义。
106例未经治疗的晚期GOA患者纳入了PRODIGE 17-ACCORD 20试验的辅助研究。在第0天（D0）和第28天（D28）使用CellSearch系统检测外周血中的CTC。通过测试多个阈值分析D0和D28时CTC的预后价值。
基线时，CTC计数中位数为1（范围0 - 415）。虽然D0时CTC≥1、2或3均与较差的总生存期（OS）和无进展生存期（PFS）显著相关，但D0或D28时，CTC≥2是最佳阈值。D28时CTC≥2也可预测疾病控制情况。综合考虑D0和D28时的CTC计数可分为3组（低/低、高/低和低 - 高/高），其PFS（p = 0.0002）和OS（p = 0.003）有显著差异。
在晚期GOA中，基线及治疗期间的CTC定量可能是一种有用的预后工具，因为它与较差的PFS和OS相关。阈值≥2个CTC似乎具有最佳判别价值。基线至D28期间CTC计数的变化有助于为每位患者量身定制治疗方案。
