Tamminga Menno, de Wit Sanne, Schuuring Ed, Timens Wim, Terstappen Leon W M M, Hiltermann T Jeroen N, Groen Harry J M
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Medical Cell BioPhysics, Faculty of Sciences and Technology, University of Twente, Enschede, The Netherlands.
Transl Lung Cancer Res. 2019 Dec;8(6):854-861. doi: 10.21037/tlcr.2019.11.06.
It is unknown whether the presence of circulating tumor cells (CTC), a known prognostic factor, influences treatment outcome. We investigated whether baseline CTC in non-small cell lung cancer (NSCLC) patients treated with tyrosine kinase inhibitors (TKI) or chemotherapy was associated with response to therapy.
We included consecutive advanced NSCLC patients, stratified by therapy. Before treatment the number of CTC was measured by CellSearch. Tumor response rates, progression free survival (PFS) and overall survival (OS) in patients with and without CTC at baseline were compared.
We included 86 patients (34 treated by TKI). Response rates of patients with CTC were lower than in patients without CTC (OR =0.22, P<0.01, adjusted for performance score and smoking status). In both treatment groups, the difference in response rates between patients with and without CTC was similar (TKI response: 25% with CTC versus 73% without CTC, chemotherapy response: 35% versus 51% respectively, interaction P=0.17). CTC was associated with a worse PFS [hazard ratio (HR) =2.0, 95% confidence interval (CI): 1.2-3.2, P=0.01] and OS (HR =1.7, 95% CI: 1.1-2.8, P=0.03) after adjustment for performance score and stage. The association remained significant after adding tumor response to the model (PFS: HR =1.9, 95% CI: 1.0-3.0, P=0.01, OS: HR =1.6, 95% CI: 1.0-2.6, P=0.05). No significant interaction between CTC presence and therapy was observed (P=0.42 for PFS and P=0.83 for OS).
Presence of CTC in advanced NSCLC patients is associated with low response rates, shorter PFS and OS, independent of the received therapy.
循环肿瘤细胞（CTC）作为一种已知的预后因素，其存在是否会影响治疗结果尚不清楚。我们研究了接受酪氨酸激酶抑制剂（TKI）或化疗的非小细胞肺癌（NSCLC）患者的基线CTC是否与治疗反应相关。
我们纳入了连续的晚期NSCLC患者，并根据治疗方法进行分层。治疗前，通过CellSearch检测CTC数量。比较了基线时存在和不存在CTC的患者的肿瘤反应率、无进展生存期（PFS）和总生存期（OS）。
我们纳入了86例患者（34例接受TKI治疗）。有CTC的患者的反应率低于无CTC的患者（OR =0.22，P<0.01，根据体能状态评分和吸烟状况进行校正）。在两个治疗组中，有和没有CTC的患者之间的反应率差异相似（TKI治疗反应：有CTC的患者为25%，无CTC的患者为73%；化疗反应：分别为35%和51%，交互作用P=0.17）。在根据体能状态评分和分期进行校正后，CTC与较差的PFS[风险比（HR）=2.0，95%置信区间（CI）：1.2 - 3.2，P=0.01]和OS（HR =1.7，95% CI：1.1 - 2.8，P=0.03）相关。在模型中加入肿瘤反应后，这种关联仍然显著（PFS：HR =1.9，95% CI：1.0 - 3.0，P=0.01；OS：HR =1.6，95% CI：1.0 - 2.6，P=0.05）。未观察到CTC存在与治疗之间的显著交互作用（PFS的P=0.42，OS的P=0.83）。
晚期NSCLC患者中CTC的存在与低反应率、较短的PFS和OS相关，与所接受的治疗无关。
