Circulating endothelial and endothelial progenitor cells in non-small-cell lung cancer

Clinical value of circulating endothelial cells and of soluble CD146 levels in patients undergoing surgery for non-small cell lung cancer

Background:

Previous studies indicate that endothelial injury, as demonstrated by the presence of circulating endothelial cells (CECs), may predict clinical outcome in cancer patients. In addition, soluble CD146 (sCD146) may reflect activation of angiogenesis. However, no study has investigated their combined clinical value in patients undergoing resection for non-small cell lung cancer (NSCLC).

Methods:

Data were collected from preoperative blood samples from 74 patients who underwent resection for NSCLC. Circulating endothelial cells were defined, using the CellSearch Assay, as CD146+CD105+CD45−DAPI+. In parallel, sCD146 was quantified using an ELISA immunoassay. These experiments were also performed on a group of 20 patients with small-cell lung cancer, 60 healthy individuals and 23 patients with chronic obstructive pulmonary disease.

Results:

The CEC count and the plasma level of sCD146 were significantly higher in NSCLC patients than in the sub-groups of controls (P<0.001). Moreover, an increased CEC count was associated with higher levels of sCD146 (P=0.010). Both high CEC count and high sCD146 plasma level at baseline significantly correlated with shorter progression-free survival (P<0.001, respectively) and overall survival (P=0.005; P=0.009) of NSCLC patients.

Conclusions:

The present study provides supportive evidence to show that both a high CEC count and a high sCD146 level at baseline correlate with poor prognosis and may be useful for the prediction of clinical outcome in patients undergoing surgery for NSCLC.

Lung cancer circulating tumor cells isolated by the EpCAM-independent enrichment strategy correlate with Cytokeratin 19-derived CYFRA21-1 and pathological staging

BACKGROUND

Cytokeratin 19-derived CYFRA21-1 is an acceptable lung cancer biomarker. However, whether CYFRA21-1 correlates with lung cancer circulating tumor cells (CTCs) remains unclear.

METHODS

CTCs in 42 lung cancer patients and 10 nonmalignant pulmonary disease patients were isolated by means of an EpCAM-independent enrichment strategy. Correlation of lung cancer CTCs with serum concentration of CYFRA21-1 and pathological staging was investigated.

RESULTS

Among lung cancer patients in this study, 39% (7/18) of those with normal CYFRA21-1 (≤3.3 ng/ml) and 62% (13/21) of high CYFRA21-1 (>3.3 ng/ml) patients were found to have ≥3 CTCs/7.5 ml blood. The CTCs-positive rate of stage I to IV lung cancer patients was 20% (2/10), 45% (5/11), 54% (6/11) and 70% (7/10), respectively. Comparing M0 vs M1 patients, the CTCs-positive rate was 43% (13/30) and 70% (7/10), respectively. All M1 patients (10/10) had one or more CTCs detected, whereas none of the nonmalignant pulmonary disease patients had detectable CTCs.

CONCLUSION

Lung cancer CTCs isolated by the EpCAM-independent enrichment approach correlate with CYFRA21-1 and TNM staging. Correlation of CTCs and CYFRA21-1 in lung cancer patients is of potential clinical utility in terms of early diagnosis and predicting prognosis.

[Antiangiogenic agents: current limits in thoracic oncology]

Antiangiogenic agents appear as major therapeutic options in renal, colorectal and breast cancer. Their part in thoracic oncology is still limited today except for bevacizumab. We review the current limits of antiangiogenic agents in terms of efficacy, activity, tolerance and therapeutic strategies. Problems about predictive biomarkers and cost-effectiveness of antiangiogenic agents in thoracic oncology are also mentioned.