Prognostic significance of circulating tumor cell measurement in the peripheral blood of patients with nasopharyngeal carcinoma

Clinical significances of RPL15 gene expression in circulating tumor cells of patients with breast cancer

The preferred biomarkers for evaluating the outcomes of patients with breast cancer (BC) remain poorly understood. The present study aimed to investigate the predictive roles of circulating tumor cells (CTCs) and ribosomal protein L 15 (RPL15) expression in the prognosis of patients with BC. A total of 170 patients were included in the present study, all of whom were female. BC was diagnosed by combining clinical features, imaging and pathological findings. CanPatrol™ technology and triple color in situ RNA hybridization were used to detect CTC subtypes and RPL15 gene expression levels. CTCs were classified into epithelial CTCs, mesenchymal CTCs (MCTCs), and hybrid CTCs (HCTCs) according to cellular surface markers. Risk factors for recurrence and metastasis were validated by a multivariate COX regression model. Kaplan-Meier survival curves were used to determine the progression-free survival (PFS) of patients. The results showed that patients with advanced tumor-node-metastasis stage and triple negative BC had high MCTCs, HCTCs and RPL15 levels (P<0.05). Furthermore, the multivariate COX regression analysis revealed that MCTCs, HCTCs, HER2+ and positive RPL15 gene expression were key factors for recurrence and metastasis of patients (P<0.05). The PFS of patients with >2 MCTCs/5 ml blood, >5 HCTCs/5 ml blood, and positive RPL15 gene expression in CTCs were significantly shorter than that of patient with 2 MCTCs, 5 HCTCs, and negative RPL15 gene expression in CTCs (P<0.05). By contrast, the PFS of patients with positive HER2 also was significantly shorter than that of patients with negative HER2. Overall, the present data indicated that the PFS of patients with BC with >2 MCTC or >5 HCTCs, and positive RPL15 gene expression was shorter than that of those with 2 MCTCs or 5 HCTCs, and negative RPL15 gene expression. Additionally, the prognosis of patients with BC with negative HER2 is more favorable than the prognosis of patients with positive HER2 expression.

Biomarkers for the detection of circulating tumor cells

Circulating tumor cells (CTCs) have emerged as a key biomarker in cancer detection and prognosis, and their molecular profiling is gaining importance in precision oncology. Liquid biopsies, which allow the extraction of CTCs, circulating tumor DNA (ctDNA) or cell-free DNA (cfDNA), have measurable advantages over traditional tissue biopsies, especially when molecular material is difficult to obtain. However, this method is not without limitations. Difficulties in differentiating between primary and metastatic lesions, uncertain predictive values and the complexity of the biomarkers used can prove challenging. Recently, high cell heterogeneity has been identified as the main obstacle to achieving high diagnostic accuracy. Because not all cells undergo epithelial-mesenchymal transition (EMT) at the same time, there is a large population of hybrid CTCs that express both epithelial and mesenchymal markers. Since traditional diagnostic tools primarily detect epithelial markers, they are often unable to detect cells with a hybrid phenotype; therefore, additional markers may be required to avoid false negatives. In this review, we summarize recent reports on emerging CTCs markers, with particular emphasis on their use in cancer diagnosis. Most of them, including vimentin, TWIST1, SNAI1, ZEB1, cadherins, CD44, TGM2, PD-L1 and GATA, hold promise for the detection of CTCs, but are also implicated in cancer progression, metastasis, and therapeutic resistance. Therefore, understanding the nature and drivers of epithelial-mesenchymal plasticity (EMP) is critical to advancing our knowledge in this field.

The correlation between epithelial-mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma

Background

Epithelial-mesenchymal transition (EMT) and circulating tumor cells (CTCs) are key prognostic factors in nasopharyngeal carcinoma (NPC). However, the role of EMT status in CTCs for predicting outcomes in advanced NPC treated with radiotherapy after induction chemotherapy remains unclear.

Methods

A total of 143 CTC tests from 95 advanced/metastatic NPC patients were analyzed before, during, and after radiotherapy, with a 60-month follow-up. CTC count, matrix metalloproteinase 2 (MMP2)) protein expression, and EMT subtypes were examined.

Results

During radiotherapy, CTC counts increase but decrease afterward. Patients with higher pre-radiotherapy tumor-node-metastasis (TNM) stages have lower total and M-subtype CTC counts. Higher T and TNM stages during radiotherapy correlate with increased EMT-state CTCs, especially hybrid CTCs. EA/IgG-positive patients have a higher number of hybrid CTCs and E-type (epithelial + hybrid) CTCs, while EBV-EA-negative patients have more mesenchymal CTCs. A higher post-radiotherapy CTC count predicts relapse, and the positive rate of MMP2 expression on hybrid and epithelial CTCs is higher than that on mesenchymal CTCs.

Conclusion

EMT status, particularly in hybrid CTCs, is a potential prognostic marker for relapse in advanced NPC after radiotherapy.

Circulating tumor cells in solid malignancies: From advanced isolation technologies to biological understanding and clinical relevance in early diagnosis and prognosis

Circulating tumor cells (CTCs) are shed from primary tumors and travel through the body via circulation, eventually settling to form micrometastases under favorable conditions. Numerous studies have identified CTCs as a negative prognostic indicator for survival across various cancer types. CTCs mirror the current heterogeneity and genetic and biological state of tumors, making their study invaluable for understanding tumor progression, cell senescence, and cancer dormancy. However, their isolation and characterization still poses a major challenge that limits their clinical translation. A wide array of methods, each with different levels of specificity, utility, cost, and sensitivity, have been developed to isolate and characterize CTCs. Moreover, innovative techniques are emerging to address the limitations of existing methods. In this review, we provide insights into CTC biology addressing spectra of markers employed for molecular analysis and functional characterization. It also emphasizes current label-dependent and label-independent isolation procedures, addressing their strengths and limitations. SIGNIFICANCE: A comprehensive overview of CTC biology, their molecular and functional characterization, along with their current clinical utility will help in understanding the present-day extent to which the clinical potential of CTCs is getting tapped in personalized medicine.

A revolutionary era in advancing precision immuno-oncology; role of circulating tumor cells

Despite a substantial progress in the development of strategies against cancer, cancer still remains a major global health issue due to a high recurrence rate, and severe side effects, leading basic medical scientists and clinical specialists toward more efficient diagnostics, prognostics, and therapeutics. Therefore, there is an imperative need for a comprehensive understanding on the cellular immunopathophysiology involved in the tumor microenvironment. In addition, results from a wide range of studies depicted that an aberration in the cellular mechanisms and immunopathophysiological interactions like Circulating Tumor Cells (CTCs) plays an indispensable role in the metastasis and tumor progression, revolutionizing cancer management by offering non-invasive detection methods and a real-time monitoring of tumor dynamics. Moreover, CTCs can clarify the tumor heterogeneity and the evolution of resistance mechanisms, aiding in the early detection of tumors and informing personalized treatment strategies. An increase in CTCs count can be associated with a worsened cancer prognosis, providing promising biomarkers for tumor phenotyping, tumor spreading or relapse, and monitoring the treatment response in patients with cancer. Hence, this systematic review aims to highlight the diagnostic, prognostic, and therapeutic potentials of CTCs, necessitating further investigations and an interdisciplinary collaboration among basic medical scientists and oncologists to address the current gaps in the strategies of cancer management, precisely improving patient-care and optimized clinical outcomes.

Circulating tumor cells: a valuable indicator for locally advanced nasopharyngeal carcinoma

BACKGROUND

Advancements in nasopharyngeal carcinoma (NPC) treatment have led to a focus on personalized treatment. Circulating tumor cells (CTCs) are important for liquid biopsies and personalized treatment but are not being fully utilized. This study examined how pre- and post-treatment CTC counts, EMT subtypes, clinical characteristics, and patient prognosis are related in order to support the use of liquid biopsy in managing NPC.

METHODS

This retrospective study included 141 patients with locally advanced NPC. All patients underwent CanPatrol™ CTC detection pre- and post-treatment and were categorized into EMT subtypes: epithelial type, mixed type, and mesenchymal type. This study analyzed CTC enumeration, EMT subtypes, and their associations with clinical characteristics and survival outcomes.

RESULTS

The results indicated a positive correlation between the pre-treatment detection rate of CTCs and N stage (P < 0.01), alongside a positive correlation with the TNM clinical stage (P = 0.02). Additionally, the detection rate of mesenchymal CTCs post-treatment is positively associated with the N stage (P = 0.02). The enumeration of CTCs pre- and post-treatment is negatively correlated with prognosis and has statistical significance. Additionally, an investigation into the EMT subtypes of CTCs revealed a significant association between the presence of mesenchymal CTCs pre- and post-treatment and decreased overall survival (OS) (P < 0.05). Furthermore, T stage, N stage, TNM clinical stage, and Epstein-Barr virus (EBV) DNA were also significantly correlated with OS.

CONCLUSION

The study found that mesenchymal CTCs pre- and post-treatment, as well as the number of CTCs, were linked to a poor prognosis.

The correlation study between TOP2A gene expression in circulating tumor cells and chemotherapeutic drug resistance of patients with breast cancer

BACKGROUND

Patients with breast cancer (BC) at advanced stages have poor outcomes because of high rate of recurrence and metastasis. Biomarkers for predicting prognosis remain to be explored. This study aimed to evaluate the relationships between circulating tumor cells (CTCs) and outcomes of BC patients.

PATIENTS AND METHODS

A total of 50 female were enrolled in this study. Their diagnoses were determined by clinical characteristics, image data, and clinical pathology. CTC subtypes and TOP2A gene expression on CTCs were detected by CanPatrol™ technology and triple color in situ RNA hybridization (RNA-ISH), which divided into epithelial CTCs (eCTCs), mesenchymal CTCs (MCTCs), and hybrid CTCs (HCTCs) based on their surface markers. Hormone receptor, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression, was measured by immunohistochemistry (IHC) method before treatment. The risk factors for predicting recurrence and metastasis were calculated by COX risk regression model. The progression-free survival (PFS) of patients was determined using Kaplan-Meier survival curve.

RESULTS

The patients with a large tumor size (≥ 3 cm) and advanced tumor node metastasis (TNM) stages had high total CTCs (TCTCs) (P < 0.05). These patients also had high TOP2A expression level. COX risk regression analysis indicated that TOP2A expression levels in TCTCs, ER + , HER-2 + , and TNM stages were critical risk factors for recurrence and metastasis of patients (P < 0.05). The PFS of patients with ≥ 5 TCTCs, ≥ 3 HCTCs, and positive TOP2A expression in ≥ 3 TCTCs was significantly longer than that in patient with < 5 TCTCs, < 3 HCTCs, and TOP2A expression in < 3 TCTCs (P < 0.05). In contrast, the PFS of patients with positive hormone receptors (ER + , PR + , HER-2 +) also was dramatically lived longer than that in patients with negative hormone receptor expression.

CONCLUSIONS

High TCTC, HCTCs, and positive TOP2A gene expression on CTCs were critical biomarkers for predicting outcomes of BC patients. Positive hormone receptor expression in BC patients has significant favor PFS.