O'Toole Sharon A, Spillane Cathy, Huang Yanmei, Fitzgerald Marie C, Ffrench Brendan, Mohamed Bashir, Ward Mark, Gallagher Michael, Kelly Tanya, O'Brien Cathal, Ruttle Carmel, Bogdanska Anna, Martin Cara, Mullen Dorinda, Connolly Elizabeth, McGarrigle Sarah A, Kennedy John, O'Leary John J
Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland.
Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland.
Breast Cancer Res Treat. 2020 Jun;181(3):571-580. doi: 10.1007/s10549-020-05658-7. Epub 2020 May 6.
The association between pathological complete response (pCR) in patients receiving neoadjuvant chemotherapy (NAC) for breast cancer and Circulating Tumour Cells (CTCs) is not clear. The aim of this study was to assess whether CTC enumeration could be used to predict pathological response to NAC in breast cancer as measured by the Miller-Payne grading system.
Twenty-six patients were recruited, and blood samples were taken pre- and post-NAC. CTCs were isolated using the ScreenCell device and stained using a modified Giemsa stain. CTCs were enumerated by 2 pathologists and classified as single CTCs, doublets, clusters/microemboli and correlated with the pathological response as measured by the Miller-Payne grading system. χ or ANOVA was performed in SPSS 24.0 statistics software for associations.
89% of patients had invasive ductal carcinoma (IDC) and 11% invasive lobular carcinoma (ILC). At baseline 85% of patients had CTCs present, median 7 (0-161) CTCs per 3 ml of whole blood. Post-chemotherapy, 58% had an increase in CTCs. This did not correlate with the Miller-Payne grade of response. No significant association was identified between the number of CTCs and clinical characteristics; however, we did observe a correlation between pre-treatment CTC counts and body mass index, p < 0.05.
Patients with a complete response to NAC still had CTCs present, suggesting enumeration is not sufficient to aid surgery stratification. Additional characterisation and larger studies are needed to further characterise CTCs isolated pre- and post-chemotherapy. Long-term follow-up of these patients will determine the significance of CTCs in NAC breast cancer patients.
接受乳腺癌新辅助化疗（NAC）的患者中，病理完全缓解（pCR）与循环肿瘤细胞（CTC）之间的关联尚不清楚。本研究的目的是评估CTC计数是否可用于预测乳腺癌患者对NAC的病理反应，该反应通过米勒-佩恩分级系统来衡量。
招募了26名患者，在NAC前后采集血样。使用ScreenCell装置分离CTC，并使用改良吉姆萨染色法进行染色。由2名病理学家对CTC进行计数，并将其分类为单个CTC、双联体、簇/微栓子，并与通过米勒-佩恩分级系统测量的病理反应相关联。在SPSS 24.0统计软件中进行χ检验或方差分析以评估相关性。
89%的患者患有浸润性导管癌（IDC），11%患有浸润性小叶癌（ILC）。基线时，85%的患者存在CTC，每3毫升全血中CTC的中位数为7（0-161）个。化疗后，58%的患者CTC数量增加。这与米勒-佩恩反应分级无关。未发现CTC数量与临床特征之间存在显著关联；然而，我们确实观察到治疗前CTC计数与体重指数之间存在相关性，p<0.05。
对NAC有完全反应的患者仍存在CTC，这表明计数不足以辅助手术分层。需要进一步的特征描述和更大规模的研究来进一步表征化疗前后分离的CTC。对这些患者的长期随访将确定CTC在NAC乳腺癌患者中的意义。
