高危前列腺癌患者接受放化疗后循环肿瘤细胞的检测及其动态变化：一项前瞻性 II 期研究。
Detection and dynamics of circulating tumor cells in patients with high-risk prostate cancer treated with radiotherapy and hormones: a prospective phase II study.
机构信息
Radiation Oncology Department, Hospital Universitario de la Princesa, Health Research Institute IIS-IP, Diego de León 62, 28006, Madrid, Spain.
Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
出版信息
Radiat Oncol. 2020 Jun 1;15(1):137. doi: 10.1186/s13014-020-01577-5.
BACKGROUND
Circulating tumor cells (CTCs) are an established prognostic marker in castration-resistant prostate cancer but have received little attention in localized high-risk disease. We studied the detection rate of CTCs in patients with high-risk prostate cancer before and after androgen deprivation therapy and radiotherapy to assess its value as a prognostic and monitoring marker.
PATIENTS AND METHODS
We performed a prospective analysis of CTCs in the peripheral blood of 65 treatment-naïve patients with high-risk prostate cancer. EpCAM-positive CTCs were enumerated using the CELLSEARCH system at 4 timepoints. A cut off of 0 vs ≥ 1 CTC/7.5 ml blood was defined as a threshold for negative versus positive CTCs status.
RESULTS
CTCs were detected in 5/65 patients (7.5%) at diagnosis, 8/62 (12.9%) following neoadjuvant androgen deprivation and 11/59 (18.6%) at the end of radiotherapy, with a median CTC count/7.5 ml of 1 (range, 1-136). Only 1 patient presented a positive CTC result 9 months after radiotherapy. Positive CTC status (at any timepoint) was not significantly associated with any clinical or pathologic factors. However, when we analyzed variations in CTC patterns following treatment, we observed a significant association between conversion of CTCs and stages T3 (P = 0.044) and N1 (P = 0.002). Detection of CTCs was not significantly associated with overall survival (P > 0.40).
CONCLUSIONS
Our study showed a low detection rate for CTCs in patients with locally advanced high-risk prostate cancer. The finding of a de novo positive CTC count after androgen deprivation therapy is probably due to a passive mechanism associated with the destruction of the tumor. Further studies with larger samples and based on more accurate detection of CTCs are needed to determine the potential prognostic and therapeutic value of this approach in non-metastatic prostate cancer.
TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT01800058.
背景
循环肿瘤细胞（CTCs）是一种已确立的前列腺癌去势抵抗性预后标志物，但在局部高危疾病中关注较少。我们研究了雄激素剥夺治疗和放疗前和后高危前列腺癌患者中 CTC 的检出率，以评估其作为预后和监测标志物的价值。
患者和方法
我们对 65 例初治高危前列腺癌患者的外周血进行了前瞻性 CTC 分析。使用 CELLSEARCH 系统在 4 个时间点计数 EpCAM 阳性 CTC。将 0 与≥1 CTC/7.5ml 血液的比值定义为 CTC 阴性与阳性的截断值。
结果
65 例患者中有 5 例（7.5%）在诊断时、62 例中有 8 例（12.9%）在新辅助雄激素剥夺后和 59 例中有 11 例（18.6%）在放疗结束时检测到 CTCs，中位 CTC 计数/7.5ml 为 1（范围，1-136）。仅 1 例患者在放疗后 9 个月出现阳性 CTC 结果。阳性 CTC 状态（任何时间点）与任何临床或病理因素均无显著相关性。然而，当我们分析治疗后 CTC 模式的变化时，我们观察到 CTC 转换与 T3 期（P=0.044）和 N1 期（P=0.002）之间存在显著相关性。CTC 检测与总生存期无显著相关性（P>0.40）。
结论
我们的研究显示局部晚期高危前列腺癌患者中 CTC 的检出率较低。雄激素剥夺治疗后新出现阳性 CTC 计数可能是由于与肿瘤破坏相关的被动机制所致。需要进一步进行具有更大样本量和更准确的 CTC 检测的研究，以确定这种方法在非转移性前列腺癌中的潜在预后和治疗价值。
试验注册
ClinicalTrials.gov ID：NCT01800058。
Zotero 插件