Circulating Tumor Cells in Breast Cancer Patients Treated by Neoadjuvant Chemotherapy: A Meta-analysis.

J Natl Cancer Inst 2018 06;110(6):560-567

Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.

Background: We conducted a meta-analysis in nonmetastatic breast cancer patients treated by neoadjuvant chemotherapy (NCT) to assess the clinical validity of circulating tumor cell (CTC) detection as a prognostic marker.

Methods: We collected individual patient data from 21 studies in which CTC detection by CellSearch was performed in early breast cancer patients treated with NCT. The primary end point was overall survival, analyzed according to CTC detection, using Cox regression models stratified by study. Secondary end points included distant disease-free survival, locoregional relapse-free interval, and pathological complete response. All statistical tests were two-sided.

Results: Data from patients were collected before NCT (n = 1574) and before surgery (n = 1200). CTC detection revealed one or more CTCs in 25.2% of patients before NCT; this was associated with tumor size (P < .001). The number of CTCs detected had a detrimental and decremental impact on overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P < .001), but not on pathological complete response. Patients with one, two, three to four, and five or more CTCs before NCT displayed hazard ratios of death of 1.09 (95% confidence interval [CI] = 0.65 to 1.69), 2.63 (95% CI = 1.42 to 4.54), 3.83 (95% CI = 2.08 to 6.66), and 6.25 (95% CI = 4.34 to 9.09), respectively. In 861 patients with full data available, adding CTC detection before NCT increased the prognostic ability of multivariable prognostic models for overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P = .008).

Conclusions: CTC count is an independent and quantitative prognostic factor in early breast cancer patients treated by NCT. It complements current prognostic models based on tumor characteristics and response to therapy.

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http://dx.doi.org/10.1093/jnci/djy018DOI Listing
June 2018
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References

(Supplied by CrossRef)
Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy
King et al.
Nat Rev Clin Oncol. 2015
Pathological complete response and long-term clinical benefit in breast cancer: The CTNeoBC pooled analysis
Cortazar et al.
Lancet. 2014
The neoadjuvant model is still the future for drug development in breast cancer
DeMichele et al.
Clin Cancer Res. 2015
Clinical implications of cancer self-seeding
Comen et al.
Nat Rev Clin Oncol. 2011
Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases
Allard et al.
Clin Cancer Res. 2004
Challenges in the enumeration and phenotyping of CTC
Coumans et al.
Clin Cancer Res. 2012
International study on inter-reader variability for circulating tumor cells in breast cancer
Ignatiadis et al.
Breast Cancer Res. 2014
Clinical validity of circulating tumour cells in patients with metastatic breast cancer: A pooled analysis of individual patient data
Bidard et al.
Lancet Oncol. 2014
Decline in circulating tumor cell count and treatment outcome in advanced prostate cancer
Lorente et al.
Eur Urol. 2016
Evaluation and prognostic significance of circulating tumor cells in patients with non-small-cell lung cancer
Krebs et al.
J Clin Oncol. 2011
Tumourigenic non-small-cell lung cancer mesenchymal circulating tumour cells: A clinical case study
Morrow et al.
Ann Oncol. 2016

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