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J Natl Cancer Inst. 2018 Jun 1;110(6):560-567. doi: 10.1093/jnci/djy018.

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

Author information

1
Institut Curie, UVSQ and Paris Saclay University, Saint Cloud, France.
2
Gustave Roussy, Villejuif, France.
3
Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
4
University of California at San Francisco, San Francisco, CA.
5
MD Anderson Cancer Center, Houston, TX.
6
Oslo University Hospital, Oslo, Norway.
7
Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
8
Gunma University Hospital, Gunma, Japan.
9
Hospital Arnau de Vilanova, Valencia, Spain.
10
Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
11
Kyoto University Hospital, Kyoto, Japan.
12
Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain.
13
Women's Health Center, University of Tuebingen, Tuebingen, Germany.
14
Women Cancer Centre, University of Trieste, ASST of Cremona, Cremona, Italy.
15
Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
16
University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
17
Complejo Hospitalario Universitario, Santiago de Compostela, Spain.
18
Imperial College, London, UK.
19
Institut Paoli Calmettes, Aix Marseille University, CNRS, Inserm, Marseilles, France.
20
Institut Curie, PSL Research University, Paris, France.
21
German Breast Group, Neu-Isenburg, Germany.
22
Institut Curie, Inserm U900, Saint Cloud, France.
23
LMBA, Université de Bretagne Sud, Vannes, France.
24
International Drug Development Institute, Louvain La Neuve, Belgium.

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.

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.

PMID:
29659933
DOI:
10.1093/jnci/djy018
[Indexed for MEDLINE]

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