Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Breast Surgery-Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Clin Cancer Res. 2020 Apr 15;26(8):1886-1895. doi: 10.1158/1078-0432.CCR-19-2670. Epub 2020 Feb 3.
There is a need for sensitive, reproducible biomarkers for patients with stage III melanoma to guide clinical decision making. Circulating tumor cells (CTCs) can be detected in patients with melanoma; however, there are limited data regarding their significance in stage III disease. The aim of this study was to determine whether CTCs are associated with early relapse in stage III melanoma.
We prospectively assessed CTCs at first presentation in clinic (baseline) for 243 patients with stage III melanoma. CTCs were measured using the CellSearch System. Relapse-free survival (RFS) was compared between patients with one or more baseline CTC versus those with no CTCs. Log-rank test and Cox regression analysis were applied to establish associations of CTCs with RFS.
At least one baseline CTC was identified in 90 of 243 (37%) patients. Forty-five (19%), 67 (28%), 118 (49%), and 13 (5%) patients were stage IIIA, IIIB, IIIC, or IIID, respectively. CTC detection was not associated with substage, or primary tumor characteristics. Multivariable analysis demonstrated that the detection of ≥1 baseline CTC was significantly associated with decreased 6-month RFS [log-rank, < 0.0001; HR, 3.62, 95% confidence interval (CI), 1.78-7.36; < 0.0001] and 54-month RFS (log-rank, = 0.01; HR, 1.69; 95% CI, 1.13-2.54; = 0.01).
≥1 CTC was independently associated with melanoma relapse, suggesting that CTC assessment may be useful to identify patients at risk for relapse who could derive benefit from adjuvant therapy.
需要有敏感、可重现的生物标志物来指导 III 期黑色素瘤患者的临床决策。循环肿瘤细胞（CTC）可在黑色素瘤患者中检测到；然而，关于其在 III 期疾病中的意义的数据有限。本研究旨在确定 CTC 是否与 III 期黑色素瘤的早期复发有关。
我们前瞻性地评估了 243 例 III 期黑色素瘤患者首次就诊时（基线）的 CTC。使用 CellSearch 系统测量 CTC。比较基线时有一个或多个 CTC 的患者与没有 CTC 的患者之间的无复发生存率（RFS）。对数秩检验和 Cox 回归分析用于确定 CTC 与 RFS 的关联。
243 例患者中有 90 例（37%）至少有一个基线 CTC。45（19%）、67（28%）、118（49%）和 13（5%）例患者分别为 IIIA、IIIB、IIIC 和 IIID 期。CTC 检测与亚分期或原发肿瘤特征无关。多变量分析表明，基线时检测到≥1 个 CTC 与 6 个月 RFS 降低显著相关[对数秩，<0.0001；HR，3.62，95%置信区间（CI），1.78-7.36；<0.0001]和 54 个月 RFS（对数秩，=0.01；HR，1.69；95% CI，1.13-2.54；=0.01）。
≥1 个 CTC 与黑色素瘤复发独立相关，提示 CTC 评估可能有助于识别有复发风险的患者，这些患者可能从辅助治疗中获益。
