Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Biosci Trends. 2021 May 11;15(2):107-117. doi: 10.5582/bst.2021.01017. Epub 2021 Apr 29.
Differentiating treatment necrosis from tumor recurrence poses a diagnostic conundrum for many clinicians in neuro-oncology. To investigate the potential role of circulating tumor cells (CTCs) detection in differentiating tumor recurrence and treatment necrosis in brain gliomas, we retrospectively analyzed the data of 22 consecutive patients with tumor totally removed and new enhancing mass lesion(s) showed on MRI after initial radiotherapy. The 22 patients were finally classified into tumor recurrence group (n = 10) and treatment necrosis group (n = 12), according to evidence from the clinical course (n = 11) and histological confirmation (n = 11). All 22 patients received CTCs detection, and DSC-MRP and 11C-MET-PET were performed on 20 patients (90.9%) and 17patients (77.3%) respectively. The data of the diagnosis efficacy to differentiate the two lesions by CTC detection, MPR and PET were analyzed by ROC analysis. The mean CTCs counts were significantly higher in the tumor recurrence group (6.10 ± 3.28) compared to the treatment necrosis group (1.08 ± 2.54, p < 0.001). The ROC curve showed that an optimized cell count threshold of 2 had 100% sensitivity and 91.2% specificity with AUC = 0.933 to declare tumor recurrence. The diagnostic efficacy of CTC detection was superior to rCBV of DSC-MRP and rSUV in MET-PET. Furthermore, we observed that CTCs detection could have a potential role in predicting tumor recurrence in one patient. Our research results preliminarily showed the potential value of CTC detection in differentiating treatment necrosis from tumor recurrence in brain gliomas, and is worthy of further confirmation with large samples involved.
区分治疗性坏死与肿瘤复发对许多神经肿瘤学临床医生来说是一个诊断难题。为了研究循环肿瘤细胞（CTC）检测在区分脑胶质瘤肿瘤复发和治疗性坏死中的潜在作用，我们回顾性分析了 22 例经初始放疗后肿瘤完全切除且 MRI 显示新增强病灶的连续患者数据。根据临床病程（n=11）和组织学证实（n=11），22 例患者最终分为肿瘤复发组（n=10）和治疗性坏死组（n=12）。所有 22 例患者均接受了 CTC 检测，20 例（90.9%）和 17 例（77.3%）患者分别进行了 DSC-MRP 和 11C-MET-PET。通过 ROC 分析，分析了 CTC 检测、MPR 和 PET 对两种病变的诊断效能。肿瘤复发组 CTC 计数明显高于治疗性坏死组（6.10±3.28 vs. 1.08±2.54，p<0.001）。ROC 曲线显示，优化的细胞计数阈值为 2 时，具有 100%的灵敏度和 91.2%的特异性，AUC=0.933，可用于诊断肿瘤复发。CTC 检测的诊断效能优于 DSC-MRP 的 rCBV 和 MET-PET 的 rSUV。此外，我们观察到 CTC 检测可能对预测一名患者的肿瘤复发具有潜在作用。我们的研究结果初步表明，CTC 检测在区分脑胶质瘤治疗性坏死与肿瘤复发方面具有潜在价值，值得进一步用大样本进行验证。
