Back to Search
Start Over
Circulating Tumor Cells in Breast Cancer Patients Treated by Neoadjuvant Chemotherapy: A Meta-analysis.
- Source :
-
Journal of the National Cancer Institute [J Natl Cancer Inst] 2018 Jun 01; Vol. 110 (6), pp. 560-567. - Publication Year :
- 2018
-
Abstract
- 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.<br />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.<br />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).<br />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.
- Subjects :
- Adult
Aged
Aged, 80 and over
Biomarkers, Tumor blood
Breast Neoplasms blood
Female
Humans
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local blood
Neoplasm Recurrence, Local diagnosis
Neoplasm Recurrence, Local drug therapy
Neoplasm Recurrence, Local pathology
Predictive Value of Tests
Prognosis
Treatment Outcome
Antineoplastic Agents therapeutic use
Breast Neoplasms diagnosis
Breast Neoplasms drug therapy
Neoplastic Cells, Circulating pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2105
- Volume :
- 110
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of the National Cancer Institute
- Publication Type :
- Academic Journal
- Accession number :
- 29659933
- Full Text :
- https://doi.org/10.1093/jnci/djy018