Department of Oncology, West China Hospital, Sichuan University, Chengdu, PR China.
Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
Radiother Oncol. 2018 Nov;129(2):396-402. doi: 10.1016/j.radonc.2018.07.022. Epub 2018 Aug 3.
The prognostic significance of circulating tumor cells (CTCs) in head and neck cancer is still under debate, as only a few studies have been reported and limited conclusions are reached. Besides, CTCs' count alone was utilized as an indicator in the previous researches. As a form of 'liquid biopsy', the further identification of genetic or phenotypic biomarkers on CTCs could possibly provide further clinical significance.
The prospective study enrolled 131 patients with nasopharyngeal carcinoma (NPC). CTCs were isolated at baseline and at the end of concurrent chemoradiotherapy, and cyclooxygenase-2 (COX-2) expression status of CTCs was detected by RNA-in situ hybridization (ISH) method. Results were correlated with patient's clinicopathological parameters and treatment outcomes. Univariate and multivariate survival analyses were performed to determine the prognostic significance.
COX-2 expression was found in 87/131 (66.4%) patients at baseline and 53/115 (46.1%) patients at the end of concurrent chemoradiotherapy. Patients with post-therapeutic COX-2 expression had significantly poorer treatment response (P = 0.011) and higher risk of tumor relapse (P = 0.026) and metastasis (P = 0.007). Besides, multivariate analysis revealed that post-therapeutic COX-2 expression on CTCs remained an independent prognostic indicator for poorer progression-free survival (HR 2.17, P = 0.019) and overall survival (HR 2.41, P = 0.024).
The study demonstrated that post-therapeutic COX-2 expression on CTCs was a novel and promising prognostic indicator for NPC patients. Future studies are needed to validate our findings and further clarify the value of integrating the indicator with current clinical strategies in improving survival of NPC patients.
循环肿瘤细胞（CTC）在头颈部癌中的预后意义仍存在争议，因为仅有少数研究报道，且得到的结论有限。此外，之前的研究仅将 CTC 计数用作指标。作为一种“液体活检”形式，进一步鉴定 CTC 上的遗传或表型生物标志物可能具有进一步的临床意义。
前瞻性研究纳入了 131 例鼻咽癌（NPC）患者。在基线和同期放化疗结束时分离 CTCs，并通过 RNA 原位杂交（ISH）方法检测 CTCs 中环氧化酶-2（COX-2）的表达状态。结果与患者的临床病理参数和治疗结果相关。进行单因素和多因素生存分析以确定预后意义。
在基线时，87/131（66.4%）例患者中发现 COX-2 表达，在同期放化疗结束时，53/115（46.1%）例患者中发现 COX-2 表达。治疗后 COX-2 表达的患者治疗反应明显较差（P=0.011），肿瘤复发（P=0.026）和转移（P=0.007）的风险更高。此外，多因素分析表明，治疗后 CTCs 上的 COX-2 表达仍然是无进展生存（HR 2.17，P=0.019）和总生存（HR 2.41，P=0.024）较差的独立预后指标。
该研究表明，治疗后 CTCs 上的 COX-2 表达是 NPC 患者的一个新的有前途的预后指标。需要进一步的研究来验证我们的发现，并进一步阐明将该指标与当前临床策略相结合以改善 NPC 患者生存的价值。
