1. Circulating Tumor Cells in Breast Cancer Patients Treated by Neoadjuvant Chemotherapy: A Meta-analysis
- Author
-
Volkmar Mueller, M. Maestro, Denise M. Wolf, Justin Stebbing, Karsten Weber, Paul Blanche, Masakazu Toi, Antonio Llombart-Cussac, Alessandra Meddis, Andreas D. Hartkopf, Jun Horiguchi, Fabien Reyal, Randi R. Mathiesen, Olav Engebraaten, Charlotte Proudhon, Laura J. Esserman, Paul Cottu, Rafael Gisbert-Criado, José A. García-Sáenz, Patrice Viens, Koenraad d'Hollander, Sara Y. Brucker, François-Clément Bidard, Maria Rosa Cappelletti, Elin Borgen, John W. Park, Dominic Amara, Daisuke Takata, Klaus Pantel, Vicente Carañana, Jaco Kraan, Jessica B. Bowman Bauldry, Stefan Michiels, Noriyoshi Fujisawa, Eduardo Díaz-Rubio, Jose Vidal-Martinez, Hideaki Tokiniwa, Françoise Rothé, Bjørn Naume, Stefan Sleijfer, Anthony Lucci, Mandar Karhade, Aurélien Latouche, Michail Ignatiadis, Carolyn S. Hall, Sibylle Loibl, Florin-Andrei Taran, Daniele Generali, Jean-Yves Pierga, Sabine Riethdorf, Jeffrey B. Smerage, Wendy Onstenk, Rin Nagaoka, Laura Muinelo-Romay, Mark Jesus M. Magbanua, Medical Oncology, Bidard, François-Clément, Michiels, Stefan, Riethdorf, Sabine, Mueller, Volkmar, Esserman, Laura J., Lucci, Anthony, Naume, Bjørn, Horiguchi, Jun, Gisbert-Criado, Rafael, Sleijfer, Stefan, Toi, Masakazu, Garcia-Saenz, Jose A., Hartkopf, Andrea, Generali, Daniele, Rothé, Françoise, Smerage, Jeffrey, Muinelo-Romay, Laura, Stebbing, Justin, Viens, Patrice, Magbanua, Mark Jesus M., Hall, Carolyn S., Engebraaten, Olav, Takata, Daisuke, Vidal-Martínez, José, Onstenk, Wendy, Fujisawa, Noriyoshi, Diaz-Rubio, Eduardo, Taran, Florin-Andrei, Rosa Cappelletti, Maria, Ignatiadis, Michail, Proudhon, Charlotte, Wolf, Denise M., Bauldry, Jessica B., Borgen, Elin, Nagaoka, Rin, Carañana, Vicente, Kraan, Jaco, Maestro, Marisa, Yvonne Brucker, Sara, Weber, Karsten, Reyal, Fabien, Amara, Dominic, Karhade, Mandar G., Mathiesen, Randi R., Tokiniwa, Hideaki, Llombart-Cussac, Antonio, Meddis, Alessandra, Blanche, Paul, D'Hollander, Koenraad, Cottu, Paul, Park, John W., Loibl, Sibylle, Latouche, Aurélien, Pierga, Jean-Yve, and Pantel, Klaus
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_treatment ,chemotherapy ,0302 clinical medicine ,Circulating tumor cell ,prognostic factor ,Neoadjuvant therapy ,Aged, 80 and over ,Hazard ratio ,Middle Aged ,Neoplastic Cells, Circulating ,Prognosis ,Neoadjuvant Therapy ,surgical procedure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Predictive value of tests ,Female ,Adult ,medicine.medical_specialty ,Antineoplastic Agents ,Breast Neoplasms ,circulating tumor cells ,circulating tumor cell ,03 medical and health sciences ,breast cancer ,Breast cancer ,SDG 3 - Good Health and Well-being ,Predictive Value of Tests ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Aged ,business.industry ,Proportional hazards model ,Surrogate endpoint ,neoadjuvant ,prognostic factors ,medicine.disease ,surgical procedures ,prognostic marker ,Confidence interval ,030104 developmental biology ,Neoplasm Recurrence, Local ,business - 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.
- Published
- 2018