Circulating tumor cells detected in follow‑up predict survival outcomes in tri‑modality management of advanced non‑metastatic esophageal cancer: a secondary analysis of the QUINTETT randomized trialBMC Cancer (2022)
Background: Our aim was to establish if presence of circulating tumor cells (CTCs) predicted worse outcome in
patients with non-metastatic esophageal cancer undergoing tri-modality therapy.
Methods: We prospectively collected CTC data from patients with operable non-metastatic esophageal cancer from
April 2009 to November 2016 enrolled in our QUINTETT esophageal cancer randomized trial (NCT00907543). Patients
were randomized to receive either neoadjuvant cisplatin and 5-fluorouracil (5-FU) plus radiotherapy followed by
surgical resection (Neoadjuvant) or adjuvant cisplatin, 5-FU, and epirubicin chemotherapy with concurrent extended
volume radiotherapy following surgical resection (Adjuvant). CTCs were identified with the CellSearch® system before
the initiation of any treatment (surgery or chemoradiotherapy) as well as at 6-, 12-, and 24-months post-treatment.
The threshold for CTC positivity was one and the findings were correlated with patient prognosis.
Results: CTC data were available for 74 of 96 patients and identified in 27 patients (36.5%) at a median follow-up of
13.1months (interquartile range:6.8-24.1 months). Detection of CTCs at any follow-up visit was significantly predictive
of worse disease-free survival (DFS;hazard ratio [HR]: 2.44; 95% confidence interval [CI]: 1.41-4.24; p=0.002), regional
control (HR: 6.18; 95% CI: 1.18-32.35; p=0.031), distant control (HR: 2.93; 95% CI: 1.52-5.65;p=0.001) and overall survival
(OS;HR: 2.02; 95% CI: 1.16-3.51; p=0.013). After adjusting for receiving neoadjuvant vs. adjuvant chemoradiotherapy,
the presence of CTCs at any follow-up visit remained significantly predictive of worse OS ([HR]:2.02;95% [Cl]:1.16-3.51;p=0.013) and DFS (HR: 2.49;95% Cl: 1.43-4.33; p=0.001). Similarly, any observed increase in CTCs was significantly
predictive of worse OS (HR: 3.14; 95% CI: 1.56-6.34; p=0.001) and DFS (HR: 3.34; 95% CI: 1.67-6.69; p<0.001).
Conclusion: The presence of CTCs in patients during follow-up after tri-modality therapy was associated with significantly poorer DFS and OS regardless of timing of chemoradiotherapy.
- Circulating tumor cells,
- Esophageal cancer
Publication DateSummer June 30, 2022
Citation InformationEdward Yu, Alison Allan, Michael Sanatani, Debra Lewis, et al.. "Circulating tumor cells detected in follow‑up predict survival outcomes in tri‑modality management of advanced non‑metastatic esophageal cancer: a secondary analysis of the QUINTETT randomized trial" BMC Cancer Vol. 22 Iss. 1 (2022) p. 746
Available at: http://works.bepress.com/edwardyu/120/