Knipper Sophie, Riethdorf Sabine, Werner Stefan, Tilki Derya, Graefen Markus, Pantel Klaus, Maurer Tobias
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Tumour Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Eur Urol Open Sci. 2021 Nov 2;34:55-58. doi: 10.1016/j.euros.2021.09.017. eCollection 2021 Dec.
Promising oncological results have been reported for salvage lymph node dissection (SLND) with prostate-specific membrane antigen-radioguided surgery (PSMA-RGS) in patients with prostate cancer (PCa) recurrence. We performed a proof-of-principle study assessing circulating tumour cells (CTCs) as a prognostic marker in patients undergoing SLND. Twenty consecutive patients with recurrent PCa treated with PSMA-RGS during April-July 2019 for PSMA-positive LNs were evaluated. Preoperative CTC counts were assessed using the US Food and Drug Administration-approved CellSearch system. Biochemical recurrence (BCR)-free survival (BFS) and therapy-free survival (TFS) were evaluated using the Kaplan-Meier method. Overall, three patients (15%) were CTC-positive. Postoperatively, CTC-positive patients had more pathologically positive LNs (median 8 vs 2) without a difference in overall LN count. During median follow-up of 10.1 mo, 14 patients experienced BCR and five received further therapy. In Kaplan-Meier analyses, median BFS was 1.4 versus 4.3 mo and median TFS was 10.3 mo versus not reached for CTC-positive versus CTC-negative patients. The main limitations are the small number of patients, the retrospective design, and short follow-up. Our pilot study suggests that CTC-positive patients seem to have worse pathological and short-term oncological outcomes. Therefore, further validation of this biomarker for treatment decision-making before local salvage therapy could be of value.
We looked at outcomes for lymph node dissection in patients with recurrence of prostate cancer. We found that outcomes appear to be worse when circulating tumour cells (CTCs) can be measured in the blood preoperatively. We conclude that detection of CTCs indicates spread of tumour cells via the blood, which may limit the benefit of lymph node dissection. Thus, CTCs should be investigated in further studies as a potential marker to help in selecting patients who could benefit from lymph node dissection if their prostate cancer recurs.
已有报道称，对于前列腺癌（PCa）复发患者，采用前列腺特异性膜抗原放射性引导手术（PSMA-RGS）进行挽救性淋巴结清扫术（SLND）可取得良好的肿瘤学效果。我们进行了一项原理验证研究，评估循环肿瘤细胞（CTC）作为接受SLND患者的预后标志物。对2019年4月至7月期间连续20例因PSMA阳性淋巴结而接受PSMA-RGS治疗的复发性PCa患者进行了评估。术前使用美国食品药品监督管理局批准的CellSearch系统评估CTC计数。采用Kaplan-Meier方法评估无生化复发（BCR）生存期（BFS）和无治疗生存期（TFS）。总体而言，3例患者（15%）CTC呈阳性。术后，CTC阳性患者的病理阳性淋巴结更多（中位数分别为8个和2个），但淋巴结总数无差异。在中位随访10.1个月期间，14例患者出现BCR，5例接受了进一步治疗。在Kaplan-Meier分析中，CTC阳性患者与CTC阴性患者相比，中位BFS分别为1.4个月和4.3个月，中位TFS分别为10.3个月和未达到。主要局限性在于患者数量少、回顾性设计以及随访时间短。我们的初步研究表明，CTC阳性患者似乎具有更差的病理和短期肿瘤学结局。因此，在局部挽救性治疗前进一步验证该生物标志物用于治疗决策可能具有价值。
我们观察了前列腺癌复发患者淋巴结清扫术的结局。我们发现，术前血液中可检测到循环肿瘤细胞（CTC）时，结局似乎更差。我们得出结论，CTC的检测表明肿瘤细胞通过血液扩散，这可能会限制淋巴结清扫术的益处。因此，在进一步研究中应将CTC作为一种潜在标志物进行研究，以帮助选择如果前列腺癌复发可能从淋巴结清扫术中获益的患者。
