Liu Hailong, Ding Jie, Wu Yanyuan, Wu Di, Qi Jun
Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, People's Republic of China.
Cancer Manag Res. 2020 Jun 15;12:4549-4560. doi: 10.2147/CMAR.S253997. eCollection 2020.
Although circulating tumor cells (CTCs) are considered as a surrogate marker in monitoring disease progression and treatment response in late stage prostate cancer (PCa), its clinical impact in localized PCa remains unclear, indicating the limitation that is simply based on cell count. This perspective observational study aimed to detect the epithelial-to-mesenchymal transition (EMT) subtypes of CTCs in localized PCa and analyze their clinical relevance and application in predicting PCa stages before surgery compared with the Partin table.
Between August 2017 and April 2019, 80 newly diagnosed localized PCa patients were enrolled in the study. Peripheral blood samples (5 mL) were collected prior to surgery. The CanPatrol CTC enrichment technique, a size-based isolation method, was used to detect the EMT CTCs. Clinical relevance of the CTCs was analyzed with Spearman's rank correlation test. Models to predict pathological were built with multivariate logistic regression. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis were performed to evaluate the accuracy of the prediction model.
CTCs were detected in 55% of all patients. The biophenotypic CTCs were most valuable and closely correlated with PSA, Gleason score, D'Amico risk classification, and pathological stage in localized PCa. The mesenchymal subtype was rare in this population but associated with seminal vesicle invasion, while the epithelial subtype had limited clinical significance. In addition, the biophenotypic CTCs combined with traditional clinical variables were analyzed by multivariate logistic regression to predict organ-confined disease before surgery, of which the AUC reached 0.818 and was superior to the Partin table 2017 in our cohort.
This study highlights the clinical impact of the biophenotypic CTCs in localized PCa, which was most closely related to clinical variables and could help to predict pathology outcomes before surgery.
尽管循环肿瘤细胞（CTC）被视为晚期前列腺癌（PCa）疾病进展和治疗反应监测中的替代标志物，但其在局限性PCa中的临床影响仍不明确，这表明单纯基于细胞计数存在局限性。这项前瞻性观察研究旨在检测局限性PCa中CTC的上皮-间质转化（EMT）亚型，并分析其临床相关性以及与Partin表相比在术前预测PCa分期中的应用。
2017年8月至2019年4月，80例新诊断的局限性PCa患者纳入本研究。术前采集外周血样本（5 mL）。采用基于大小分离的CanPatrol CTC富集技术检测EMT CTC。通过Spearman等级相关检验分析CTC的临床相关性。采用多因素逻辑回归建立预测病理结果的模型。进行受试者操作特征（ROC）曲线和曲线下面积（AUC）分析以评估预测模型的准确性。
所有患者中55%检测到CTC。双表型CTC最具价值，与局限性PCa中的前列腺特异性抗原（PSA）、Gleason评分、D'Amico风险分类和病理分期密切相关。间质亚型在该人群中罕见，但与精囊侵犯相关，而上皮亚型临床意义有限。此外，通过多因素逻辑回归分析双表型CTC与传统临床变量相结合以预测术前器官局限性疾病，其AUC达到0.818，在我们的队列中优于2017年的Partin表。
本研究强调了双表型CTC在局限性PCa中的临床影响，其与临床变量关系最为密切，有助于术前预测病理结果。
