Ko Josephine Mun Yee, Lam Ka On, Kwong Dora Lai Wan, Wong Ian Yu-Hong, Chan Fion Siu-Yin, Wong Claudia Lai-Yin, Chan Kwan Kit, Law Tsz Ting, Chiu Keith Wan Hang, Lam Candy Chi Shan, Wong Jean Chrysei, Fong Henry Chun Hung, Choy Faith Sin Fai, Lo Andy, Law Simon, Lung Maria Li
Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China.
Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China.
Cancers (Basel). 2023 Jan 29;15(3):832. doi: 10.3390/cancers15030832.
We aim to reveal the clinical significance and potential usefulness of dynamic monitoring of CTCs to track therapeutic responses and improve survival for advanced ESCC patients. Peripheral blood (PB) ( = 389) and azygos vein blood (AVB) ( = 13) samplings were recruited prospectively from 88 ESCC patients undergoing curative surgery from 2017 to 2022. Longitudinal CTC enumeration was performed with epithelial (EpCAM/pan-cytokeratins/MUC1) and mesenchymal (vimentin) markers at 12 serial timepoints at any of the pre-treatment, all of the post-treatments/pre-surgery, post-surgery follow-ups for 3-year, and relapse. Longitudinal real-time CTC analysis in PB and AVB suggests more CTCs are released early at pre-surgery and 3-month post-surgery into the circulation from the CTRT group compared to the up-front surgery group. High CTC levels at pre-treatments, 1-/3-month post-surgery, unfavorable changes of CTC levels between all post-treatment/pre-surgery and 1-month or 3-month post-surgery (Hazard Ratio (HR) = 6.662, < 0.001), were independent prognosticators for curative treatment. The unfavorable pre-surgery CTC status was independent prognostic and predictive for neoadjuvant treatment efficacy (HR = 3.652, = 0.035). The aggressive CTC clusters were more frequently observed in AVB compared to PB. Its role as an independent prognosticator with relapse was first reported in ESCC (HR = 2.539, = 0.068). CTC clusters and longitudinal CTC monitoring provide useful prognostic information and potential predictive biomarkers to help guide clinicians in improving disease management.
我们旨在揭示循环肿瘤细胞（CTCs）动态监测对于晚期食管癌（ESCC）患者追踪治疗反应和改善生存的临床意义及潜在效用。前瞻性纳入了2017年至2022年期间接受根治性手术的88例ESCC患者的外周血（PB）样本（n = 389）和奇静脉血（AVB）样本（n = 13）。在治疗前、所有治疗后/术前、术后3年随访以及复发的任意12个连续时间点，使用上皮标志物（EpCAM/全细胞角蛋白/MUC1）和间充质标志物（波形蛋白）进行CTCs的纵向计数。PB和AVB中CTCs的纵向实时分析表明，与直接手术组相比，放化疗联合手术组在术前和术后3个月早期有更多的CTCs释放到循环中。治疗前、术后1个月/3个月时CTCs水平高，以及所有治疗后/术前与术后1个月或3个月之间CTCs水平的不利变化（风险比（HR）= 6.662，P < 0.001），是根治性治疗的独立预后因素。术前CTCs状态不佳是新辅助治疗疗效的独立预后和预测因素（HR = 3.652，P = 0.035）。与PB相比，在AVB中更频繁地观察到侵袭性CTCs簇。其作为复发独立预后因素的作用首次在ESCC中报道（HR = 2.539，P = 0.068）。CTCs簇和CTCs纵向监测提供了有用的预后信息和潜在的预测生物标志物，以帮助指导临床医生改善疾病管理。
