Integral Oncology Division, Clinical University Hospital, Av. Dr. Olóriz 16, 18012, Granada, Spain.
Liquid Biopsy and Metastasis Research Group, GENYO, Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government PTS, Granada, Avenida de la Ilustración, 114, 18016, Granada, Spain.
J Transl Med. 2018 Sep 6;16(1):251. doi: 10.1186/s12967-018-1624-2.
The use of circulating tumor cells (CTCs) as indicators of treatment response in metastatic colorectal cancer (mCRC) needs to be clarified. The objective of this study is to compare the Response Evaluation Criteria in Solid Tumors (RECIST) with the Cytologic Criteria Assessing Response (CyCAR), based on the presence and phenotypic characterization of CTCs, as indicators of FOLFOX-bevacizumab treatment response.
77 mCRC blood samples from FOLFOX-bevacizumab treated patients were analyzed to isolate CTCs before and after (12 and 24 weeks) treatment, using an immunomagnetic separation method. VEGFR expression was identified by double immunostaining.
We observed a decrease of CTCs (42.8 vs. 18.2%) and VEGFR positivity (69.7% vs. 41.7%) after treatment. According to RECIST, 6.45% of the patients did not show any clinical benefit, whereas 93.55% patients showed a favorable response at 12 weeks. According to CyCAR, 29% had a non-favorable response and 71% patients did not. No significant differences were found between the response assessment by RECIST and CyCAR at 12 or 24 weeks. However, in the multivariate analysis, RECIST at 12 weeks and CyCAR at 24 weeks were independent prognostic factors for OS (HR: 0.1, 95% CI 0.02-0.58 and HR: 0.35, 95% CI 0.12-0.99 respectively).
CyCAR results were comparable to RECIST in evaluating the response in mCRC and can be used as an alternative when the limitation of RECIST requires additional response analysis techniques.
循环肿瘤细胞（CTC）作为转移性结直肠癌（mCRC）治疗反应的指标尚需明确。本研究旨在比较实体瘤反应评估标准（RECIST）与基于 CTC 存在和表型特征的细胞学反应评估标准（CyCAR），以评估 FOLFOX-贝伐珠单抗治疗反应的指标。
采用免疫磁珠分离法分析 77 例接受 FOLFOX-贝伐珠单抗治疗的 mCRC 患者治疗前后（12 和 24 周）的血液样本，以分离 CTCs。通过双重免疫染色鉴定血管内皮生长因子受体（VEGFR）的表达。
我们观察到治疗后 CTCs（42.8%比 18.2%）和 VEGFR 阳性（69.7%比 41.7%）减少。根据 RECIST，6.45%的患者没有任何临床获益，而 93.55%的患者在 12 周时表现出良好的反应。根据 CyCAR，29%的患者反应不佳，71%的患者没有。在 12 或 24 周时，RECIST 和 CyCAR 的反应评估之间没有发现显著差异。然而，在多变量分析中，12 周时的 RECIST 和 24 周时的 CyCAR 是 OS 的独立预后因素（HR：0.1，95%CI 0.02-0.58 和 HR：0.35，95%CI 0.12-0.99）。
CyCAR 结果与 RECIST 评估 mCRC 反应相当，当 RECIST 的局限性需要额外的反应分析技术时，可以作为替代方法。
