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Liu Z, Sun L, Zheng B, Wang H, Qin X, Zhang P, Wo Q, Li H, Mou Y, Zhang D, Wang S. The value of ATAD3A as a potential biomarker for bladder cancer. Cancer Med 2023; 12:22395-22406. [PMID: 38018291 PMCID: PMC10757082 DOI: 10.1002/cam4.6759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/28/2023] [Accepted: 09/29/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Bladder cancer (BCa) is a highly malignant tumor, and if left untreated, it can develop severe hematuria and tumor metastasis, thereby endangering the patient's life. The purpose of this paper was to detect the expression of ATAD3A in BCa and research the relationship between ATAD3A and pathological features of bladder cancer and the prognosis of patients. METHODS First, the expression of ATAD3A in BCa and normal bladder tissues was analyzed based on the UALCAN and Oncomine public databases. Second, 491 cases of surgically resected bladder cancer specimens and 110 cases of normal adjacent tissues were immunohistochemically stained. The expression of ATAD3A was quantified, and the value and prognosis of ATAD3A as a biomarker of BCa were evaluated. RESULTS The expression of ATAD3A in bladder cancer tissues was higher than that in normal bladder mucosa. High expression of ATAD3A was correlated with patient age, tumor size, number of tumors, distant metastasis, lymph node metastasis, lymphovascular invasion, and TNM stage (p < 0.05). Overexpression of ATAD3A is closely related to cancer patient survival. The mean survival time of bladder cancer patients with high ATAD3A expression was shorter than those with low ATAD3A levels. According to the relative comparing result, the high ATAD3A expression herald reduced overall survival in BCa patients. CONCLUSIONS The abnormal overexpression of ATAD3A may be related to the initiation and progress of bladder cancer. The upregulation of ATAD3A can be used as an effective indicator to diagnose bladder cancer and predict tumor progression. Furthermore, the combination of information from public databases and the results of clinical sample analysis can help us better understand the mechanism of action of molecular oncogenes in bladder cancer.
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Affiliation(s)
- Zhenghong Liu
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Li Sun
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Bin Zheng
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Heng Wang
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Xiaowen Qin
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Pu Zhang
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Qijun Wo
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Haichang Li
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Yixuan Mou
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Dahong Zhang
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Shuai Wang
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouZhejiangChina
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Liu Z, Zhang P, Wang H, Zheng B, Sun L, Zhang D, Fan J. Raman Spectrum-Based Diagnosis Strategy for Bladder Tumor. Urol Int 2021; 106:109-115. [PMID: 34515249 DOI: 10.1159/000518877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022]
Abstract
Raman spectroscopy is an optical technique that can potentially serve as a molecular diagnosis method. This approach is excellent in many aspects for diagnosing bladder tumors, and over the last 20 years, there has been a rapid increase in the number of related studies. However, no review article has covered the wide use of Raman spectroscopy in bladder tumors. A total of 26 original studies have suggested that Raman spectroscopy shows good performance in diagnosing bladder tumors from 4 aspects, including tissue sections, endoscopic methods, cell screening, and biomarkers. However, Raman spectroscopy needs to be modified by combining it with other techniques, and studies based on a large population are still urgently needed to expand its clinical value.
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Affiliation(s)
- Zhenghong Liu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China, .,Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China,
| | - Pu Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Heng Wang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Bin Zheng
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Li Sun
- Hangzhou Medical College, Hangzhou, China
| | - Dahong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jinhai Fan
- Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
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Małkiewicz B, Kiełb P, Gurwin A, Knecht K, Wilk K, Dobruch J, Zdrojowy R. The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status. ACTA ACUST UNITED AC 2021; 57:medicina57050415. [PMID: 33922894 PMCID: PMC8145304 DOI: 10.3390/medicina57050415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Jakub Dobruch
- First Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
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de Kruijff IE, Beije N, Martens JWM, de Wit R, Boormans JL, Sleijfer S. Liquid Biopsies to Select Patients for Perioperative Chemotherapy in Muscle-invasive Bladder Cancer: A Systematic Review. Eur Urol Oncol 2021; 4:204-214. [PMID: 32059957 DOI: 10.1016/j.euo.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/12/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Neoadjuvant chemotherapy (NAC) is considered the standard treatment for muscle-invasive bladder cancer (MIBC). However, its overall survival benefit is limited and toxicity is significant; hence, NAC has not been adopted universally. OBJECTIVE To systematically evaluate whether biomarkers can guide the administration of perioperative chemotherapy in MIBC patients. EVIDENCE ACQUISITION A systematic search of the PubMed database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). In total, 215 papers were screened and 22 were selected to assess the potential clinical value of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) in selecting MIBC patients for perioperative chemotherapy. EVIDENCE SYNTHESIS We found that the presence of one or more CTCs before radical cystectomy, as determined by the CellSearch technique, is a robust marker for poor recurrence-free and overall survival. Consequently, whether NAC can be withheld in patients without the presence of CTCs is a subject of ongoing investigation. Studies investigating various approaches to detect cfDNA showed that cfDNA is present in the blood of MIBC patients, but varying results on its prognostic value have been reported. Successful cfDNA-based approaches are likely to encompass at least a multitude of genes using next-generation sequencing, as there are generally few hotspot somatic mutations in MIBC. CONCLUSIONS Liquid biopsies hold promise in selecting MIBC patients for perioperative chemotherapy, but instead of more proof-of-principle studies, prospective studies investigating true clinical applicability for treatment decision making are urgently needed. PATIENT SUMMARY Liquid biopsies appear to be a promising tool to guide the administration of chemotherapy in patients with muscle-invasive bladder cancer; however, the optimal way to implement these remains to be determined.
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Affiliation(s)
- Ingeborg E de Kruijff
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nick Beije
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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5
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Zhang R, Xia J, Wang Y, Cao M, Jin D, Xue W, Huang Y, Chen H. Co-Expression of Stem Cell and Epithelial Mesenchymal Transition Markers in Circulating Tumor Cells of Bladder Cancer Patients. Onco Targets Ther 2020; 13:10739-10748. [PMID: 33122913 PMCID: PMC7588836 DOI: 10.2147/ott.s259240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Cancer cells with stemness and epithelial-to-mesenchymal transition (EMT) features display enhanced malignant and metastatic potential. This study aimed to introduce a new methodology developed in order to investigate the co-expression of a stemness (OCT4) and EMT markers on single circulating tumor cells (CTCs) of patients with localized urinary bladder cancer and their potential prognostic prediction value. Methods and Materials Between April 2015 and July 2015, blood samples of 51 consecutive patients diagnosed with high risk bladder cancer (cT1-3N0M0) were prospectively investigated for CTCs. Peripheral blood (5 mL) was drawn before primary transurethral resection. Detection of CTCs was performed using the CanPatrolTM system. Nucleic acid probes were used to identify CTCs, and expression levels of epithelial and mesenchymal genes in CTCs were examined by situ hybridization assay. Results All patients received radical cystectomy with pelvic lymph nodes dissection. CTCs were detected in 44 of 51 (86.3%) patients, respectively. The overall mean number of CTCs was 6.1 (range: 0~29; median: 4). A total of 311 CTCs were detected in PB. High OCT4 expression (OCT4high) was detected more frequently in Epi−Mes+ cells (p=0.001). Patients with pathological confirmed muscle-invasive bladder cancer (MIBC) had higher Epi−Mes+ CTCs positive rates (p=0.001) and OCT4high CTCs positive rates (p=0.019) than pathological confirmed non muscle-invasive bladder cancer (NMIBC). Regarding co-expression of these markers, Epi−Mes+/OCT4high CTCs were more frequently evident in the MIBC setting (30.4% vs 3.6% of patients, p = 0.016). Conclusion A differential expression pattern for these markers was observed both in NMIBC and MIBC disease. A subgroup of CTCs showed a CTCs expressing high OCT4, along with Mes were more frequently detected in patients with MIBC, suggesting that these cells may prevail during tumor muscle invasion and disease progression.
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Affiliation(s)
- Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jun Xia
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yiqiu Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ming Cao
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Di Jin
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yiran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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6
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Montazeri V, Ghahremani MH, Montazeri H, Hasanzad M, Safavi DM, Ayati M, Chehrazi M, Arefi Moghaddam B, Ostad SN. A Preliminary Study of NER and MMR Pathways Involved in Chemotherapy Response in Bladder Transitional Cell Carcinoma: Impact on progression-free survival. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:355-365. [PMID: 32922493 PMCID: PMC7462481 DOI: 10.22037/ijpr.2020.112646.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
One of the main genotoxic drugs used in bladder cancer chemotherapy is cisplatin. While it is applied in most types of cancers, resistance to cisplatin is wildly common. In order to overcome drug resistance, it is necessary to determine a predictive marker. This study was conducted to provide basic data for selecting and designing a gene profile for further cohort and RCT studies in the future to improve response to treatment in bladder cancer. The expression levels of ERCC1, MLH1, MSH2, and CTR1 mRNA were determined in the tumor tissue using real-time q-PCR. Progression-free survival (PFS) was analyzed in term of the level of genes expression. The results revealed that the level of ERCC1 mRNA expression was higher in the recurrence (R) group compared to the no recurrence (NR) group. Moreover, the PFS time was increased in the patients with an ERCC1 expression level of below 1.57. The level of MLH1 and MSH2 mRNA expression was lower in the R group compared to the NR group; therefore, PFS time was increased in the patients with MLH1 and MSH2 gene expression levels above the cutoff point. While the level of CTR1 mRNA expression was higher in the R group versus the NR group, the PFS time was longer in the patients with CTR1 expression levels of below 1.265 compared to the patients with high levels of CTR1 expression. It can be concluded that the level of ERCC1, MLH1, MSH2, and CTR1 mRNA expression may be associated with PFS time as possible therapeutic targets for decreasing cisplatin resistance.
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Affiliation(s)
- Vahideh Montazeri
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ghahremani
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Montazeri
- Department of Pharmaceutical Biotechnology, School of Pharmacy, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Mandana Hasanzad
- Medical Genomics Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - D Majid Safavi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ayati
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | | | - Seyed Nasser Ostad
- Toxicology and Poisoning Research Centre, Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Yan H, Dittmar F, Schagdarsurengin U, Wagenlehner F. The Clinical Application and Potential Roles of Circulating Tumor Cells in Bladder Cancer and Prostate Cancer. Urology 2020; 145:30-37. [PMID: 32634447 DOI: 10.1016/j.urology.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022]
Abstract
Circulating tumor cells (CTCs) are considered to be promising biomarkers in malignant diseases. Recently, molecular profiles of CTCs in prostate cancer (PCa) and the role of CTCs in neoadjuvant chemotherapy and transurethral resections of bladder cancer (BCa) are intensely studied. However, localized PCa and nonmuscle-invasive BCa are less investigated and discussed. Moreover, the benefit and feasibility of clinical applications of CTCs should be critically questioned and reevaluated. This review focuses mainly on clinical issues and lesser on methodologies, and summarizes the quintessence of available works dealing with clinical applications of CTCs in PCa and BCa management.
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Affiliation(s)
- Hang Yan
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany; Working Group Epigenetics of Urogenital System, Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Florian Dittmar
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Undraga Schagdarsurengin
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany; Working Group Epigenetics of Urogenital System, Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany
| | - Florian Wagenlehner
- Clinic and Polyclinic of Urology, Pediatric Urology and Andrology, JLU Giessen, Giessen, Hessen, Germany.
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8
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Du YY, Zhang QJ, Sun GP. Expression and Clinical Significance of Cytokeratin-19 and Thymidine Kinase-1 in Advanced Gastrointestinal Cancer. Chin Med J (Engl) 2017; 129:2168-72. [PMID: 27625087 PMCID: PMC5022336 DOI: 10.4103/0366-6999.189919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: As the clinical value of cytokeratin-19 (CK19) and thymidine kinase-1 (TK1) in advanced gastrointestinal cancer remains controversial, we investigated their expression and clinical significance in this disease. Methods: A total of 171 advanced gastrointestinal cancer patients were prospectively enrolled in this study. The mRNA level of CK19 was detected using quantitative real-time reverse transcription-polymerase chain reaction (PCR) in all patients, along with a control group of fifty healthy individuals. Furthermore, detection of TK1 protein was carried out in 96 patients using a chemiluminescence dot blot assay. The primary endpoint was overall survival (OS) time. Results: Positive CK19 mRNA expression was detected in 74 (43.3%) of the 171 patients and positive TK1 expression was detected in 66 (68.8%) of the 96 patients. Furthermore, of the 96 patients, 36 (37.5%) were positive for both TK1 protein and CK19 mRNA, 30 (31.3%) were negative for TK1 protein, and 15 (15.6%) were negative for TK1 protein and positive for CK19 mRNA. The results indicated that patients who were positive for CK19 mRNA expression had significantly shorter OS times than those who were negative for it (median OS 7.7 vs. 9.7 months, respectively; P = 0.02). Moreover, patients who were positive for CK19 mRNA and TK1 protein expression had shorter OS times (median OS 6.1 months) than those who were positive for CK19 mRNA and negative for TK1 protein expression (median OS 9.1 months; P = 0.028). Positive CK19 mRNA expression was significantly associated with shorter OS in the univariate analysis (P = 0.027). Based on a multivariate Cox regression analysis, CK19 mRNA together with TK1 protein expression (P = 0.024) was an independent predictor for OS in gastrointestinal cancer patients. Conclusions: Our results suggest that positive expression of CK19 mRNA and TK1 protein is closely correlated with poor prognosis in advanced gastrointestinal cancer. Furthermore, both CK19 and TK1 are possible gastrointestinal cancer biomarkers.
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Affiliation(s)
- Ying-Ying Du
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Qiu-Jun Zhang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Guo-Ping Sun
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
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Bünger S, Zimmermann M, Habermann JK. Diversity of assessing circulating tumor cells (CTCs) emphasizes need for standardization: a CTC Guide to design and report trials. Cancer Metastasis Rev 2016; 34:527-45. [PMID: 26323491 DOI: 10.1007/s10555-015-9582-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hematogenous spreading of tumor cells from primary tumors is a crucial step in the cascade to metastasis, the latter being the most limiting factor for patients' survival prognosis. Therefore, circulating tumor cells (CTCs) have become a field of intensive research. However, the process of isolation and identification of CTCs lacks standardization. This article presents an overview of 71 CTC studies reported in PUBMED since 2000 and focusing on colorectal cancer. These studies are evaluated regarding standardization of CTC isolation and identification, marker proteins used, study population and blood sample quality management, clinical performance, and quality measures. Overall, standardization of CTC assessment seems insufficient. Thus, comparability of CTC studies is hampered and results should be interpreted carefully. We here propose a standardized CTC guideline (CTC Guide) to prospectively design and report studies/trials in a harmonized form. Despite the current interstudy heterogeneity, the data indicate that CTC detection is of clinical relevance and CTCs should be considered as a surrogate prognostic marker. Many studies indicate the high potential for CTCs as prognostic markers, e.g., in colorectal cancer treatment. However, standardized, large-scale multicenter validation studies are still needed to pave the way for clinical implementation of CTC detection that could ameliorate individualized medicine regimes.
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Affiliation(s)
- S Bünger
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Zimmermann
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J K Habermann
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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10
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Rink M, Soave A, Engel O, Fisch M, Riethdorf S, Pantel K. [Tumor cells in the peripheral blood of patients with urothelial carcinoma of the bladder: detection and impact of circulating]. Urologe A 2014; 53:501-8. [PMID: 24671248 DOI: 10.1007/s00120-014-3443-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Circulating tumor cells (CTC) play a crucial role in the natural history of several malignancies and, thus, are the subject of intense research efforts. This review summarizes the most contemporary literature data regarding detection of CTC and their impact on the oncological prognosis of patients with urothelial carcinoma of the bladder (UCB). Despite the availability of different methods for CTC detection and isolation in the peripheral blood, the standardized and Food and Drug Administration-approved CellSearch® assay is currently the most commonly used system for CTC detection. The majority of studies did not find any association between presence of CTC and clinicopathologic features. However, CTC have been demonstrated to represent a strong, independent predictor for unfavorable oncological outcomes in UCB. Since the peripheral blood is an easily accessible source, CTC represent a promising biomarker to effectively monitor early disease progression and therapy response in the near future. CTC hold the potential to individualize patient counseling regarding the optimal timing of radical surgery or bladder-sparing treatment as well as multimodal therapies.
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Affiliation(s)
- M Rink
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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11
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Langevin SM, Houseman EA, Accomando WP, Koestler DC, Christensen BC, Nelson HH, Karagas MR, Marsit CJ, Wiencke JK, Kelsey KT. Leukocyte-adjusted epigenome-wide association studies of blood from solid tumor patients. Epigenetics 2014; 9:884-95. [PMID: 24671036 DOI: 10.4161/epi.28575] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Epigenome-wide studies of DNA methylation using blood-derived DNA from cancer patients are complicated by the heterogeneity of cell types within blood and the associated cell lineage specification of DNA methylation signatures. Here, we applied a novel set of analytic approaches to assess the association between cancer case-status and DNA methylation adjusted for leukocyte variation using blood specimens from three case-control cancer studies (bladder: 223 cases, 205 controls; head and neck: 92 cases, 92 controls; and ovarian: 131 cases, 274 controls). Using previously published data on leukocyte-specific CpG loci and a recently described approach to deconvolute subject-specific blood composition, we performed an epigenome-wide analysis to examine the association between blood-based DNA methylation patterns and each of the three aforementioned solid tumor types adjusted for cellular heterogeneity in blood. After adjusting for leukocyte profile in our epigenome-wide analysis, the omnibus association between case-status and methylation was significant for all three studies (bladder cancer: P = 0.047; HNSCC: P = 0.013; ovarian cancer: P = 0.0002). Subsequent analyses revealed that CpG sites associated with cancer were enriched for transcription factor binding motifs involved with cancer-associated pathways. These results support the existence of cancer-associated DNA methylation profiles in the blood of solid tumor patients that are independent of alterations in normal leukocyte distributions. Adoption of the methods developed here will make it feasible to rigorously assess the influence of variability of normal leukocyte profiles when investigating cancer related changes in blood-based epigenome-wide association studies.
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Affiliation(s)
- Scott M Langevin
- Department of Environmental Health; University of Cincinnati College of Medicine; Cincinnati, OH USA; Department of Epidemiology; Brown University; Providence, RI USA
| | - E Andres Houseman
- Department of Biostatistics; Oregon State University College of Public Health and Human Sciences; Corvallis, OR USA
| | - William P Accomando
- Department of Pathology & Laboratory Medicine; Brown University; Providence, RI USA
| | - Devin C Koestler
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Dartmouth Medical School; Lebanon, NH USA
| | - Brock C Christensen
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Dartmouth Medical School; Lebanon, NH USA; Department of Pharmacology and Toxicology; Dartmouth Medical School; Lebanon, NH USA
| | - Heather H Nelson
- Division of Epidemiology and Community Health; University of Minnesota Masonic Cancer Center; Minneapolis, MN USA
| | - Margaret R Karagas
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Dartmouth Medical School; Lebanon, NH USA
| | - Carmen J Marsit
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Dartmouth Medical School; Lebanon, NH USA; Department of Pharmacology and Toxicology; Dartmouth Medical School; Lebanon, NH USA
| | - John K Wiencke
- Department of Neurological Surgery; University of California San Francisco; San Francisco, CA USA
| | - Karl T Kelsey
- Department of Epidemiology; Brown University; Providence, RI USA; Department of Pathology & Laboratory Medicine; Brown University; Providence, RI USA
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Ju M, Kao GD, Steinmetz D, Chandrasekaran S, Keefe SM, Guzzo TJ, Christodouleas JP, Hahn SM, Dorsey JF. Application of a telomerase-based circulating tumor cell (CTC) assay in bladder cancer patients receiving postoperative radiation therapy: a case study. Cancer Biol Ther 2014; 15:683-7. [PMID: 24618718 DOI: 10.4161/cbt.28412] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Muscle invasive bladder carcinoma is an often lethal disease that requires aggressive treatment. Improved assays would contribute to better risk prediction and clinical management of this disease. A telomerase-based assay to detect circulating tumor cells (CTCs) may usefully fulfill this role. METHODS Two patients (C1 and C2) were enrolled onto an IRB-approved bladder biomarker study before initiating post-operative radiation therapy (RT) for muscle invasive bladder carcinoma. Blood samples were taken at predefined intervals: before, during, and after RT and then retrospectively correlated with imaging studies and disease course. RESULTS C1 began RT for positive resection margins on surgical pathology, at which time CTCs were undetectable and pelvic imaging demonstrated no evidence of disease. However, following the completion of treatment, the patient's CTC count was found to have increased to 202 CTCs/mL, and MRI demonstrated new abdominal and pelvic masses consistent with progressive disease. C1 ultimately died of disease with distant and local failure. Conversely, C2 was found to have 632 CTCs/mL before the initiation of RT for positive surgical margins, although imaging demonstrated no visible masses. At the conclusion of RT, repeat imaging showed changes that were indeterminate for either tumor recurrence or post-radiation effects. However, the patient's CTC count had dropped to 184 CTCs/mL. Furthermore, a second follow-up assay performed 6 months later revealed no detectable CTCs and repeat imaging showed complete resolution of worrisome imaging changes, thus excluding tumor progression. CONCLUSIONS To our knowledge this is the first report of a telomerase-based assay to identify CTCs in bladder cancer patients. Further studies are required to fully determine the ultimate clinical utility of this assay. However, the two patient vignettes described here illustrate how serial CTC assays may track the disease course and inform the management of bladder cancer patients undergoing adjuvant RT and potentially chemotherapy.
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Affiliation(s)
- Melody Ju
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Gary D Kao
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - David Steinmetz
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Sanjay Chandrasekaran
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Stephen M Keefe
- Department of Medicine; Division of Hematology/Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Thomas J Guzzo
- Department of Surgery; Division of Urology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - John P Christodouleas
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Stephen M Hahn
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Jay F Dorsey
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
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Pedrosa JA, Koch MO, Cheng L. Lymph node-positive bladder cancer: surgical, pathologic, molecular and prognostic aspects. Expert Rev Anticancer Ther 2013; 13:1281-95. [PMID: 24134387 DOI: 10.1586/14737140.2013.850847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The presence of lymphatic metastasis is associated with markedly worse prognosis in patients with bladder cancer, although surgical resection and chemotherapy can still provide long-term survival for selected patients. The prognostic stratification of patients with positive lymph nodes has been broadly discussed in the current literature and a more extensive pelvic lymph node dissection and thorough pathologic assessment has been advocated. It is clear that stratification using the tumor node metastasis staging system is insufficient to adequately discriminate prognosis between patients with different lymph node involvement. Lymph node density and extranodal extension have been extensively investigated and appear to influence the prognosis of these patients. Molecular markers have been developed to improve the diagnosis of micrometastatic disease, and new targeted therapies have shown promising preclinical results and are now being tested in different clinical scenarios.
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Affiliation(s)
- Jose A Pedrosa
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Katseli A, Maragos H, Nezos A, Syrigos K, Koutsilieris M. Multiplex PCR-based detection of circulating tumor cells in lung cancer patients using CK19, PTHrP, and LUNX specific primers. Clin Lung Cancer 2013; 14:513-20. [PMID: 23810363 DOI: 10.1016/j.cllc.2013.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/13/2013] [Accepted: 04/16/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to develop a multiplex polymerase chain reaction (PCR)-based method for detection of circulating tumor cells in peripheral blood of lung cancer (LC) patients. PATIENTS AND METHODS Peripheral blood was collected from 71 healthy donors and 125 LC patients at different pathological stages. Samples were analyzed using multiplex PCR, and specific primers for CK19, PTHrP, and LUNX mRNA. The sensitivity of our method was set at 10 LC cells (A549 cells) in 3 mL of peripheral blood of healthy donors using spiking experiments. RESULTS The detection rates in LC patients for CK19, PTHrP, and LUNX were 45.6%, 64.8%, and 28%, and in healthy individuals were 7%, 7%, and 5.6%, respectively. Overall, our method produced 77.8% positive detections for at least 1 molecular marker. Twenty-eight (22.2%) were negative for expression of all markers, 39 (31.2%) were positive for expression of 1 marker, 42 (33.6%) were positive for expression of 2 markers, and 17 (13.6%) were positive for expression of all 3 markers. Detection of CK19 mRNA expression positively correlated with LC stage and distant metastases. PTHrP mRNA detection correlated positively with LC stage, presence of bone metastasis, and squamous cell carcinoma, and LUNX mRNA detection correlated with lymph node involvement. Combined detection of 2 or 3 markers was significantly correlated with metastatic disease, and negative detection of all 3 molecular markers was correlated with early stage nonmetastatic disease. CONCLUSION Multiple PCR-based detection of CK19, PTHrP, and LUNX mRNA expression provides useful information for disease stage and dissemination in LC patients.
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Affiliation(s)
- Anastasia Katseli
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Follow-up After Surgical Treatment of Bladder Cancer: A Critical Analysis of the Literature. Eur Urol 2012; 62:290-302. [DOI: 10.1016/j.eururo.2012.05.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 05/03/2012] [Indexed: 11/18/2022]
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Small AC, Gong Y, Oh WK, Hall SJ, van Rijn CJ, Galsky MD. The Emerging Role of Circulating Tumor Cell Detection in Genitourinary Cancer. J Urol 2012; 188:21-6. [DOI: 10.1016/j.juro.2012.02.2558] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Indexed: 12/13/2022]
Affiliation(s)
- Alexander C. Small
- Division of Hematology/Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York
| | - Yixuan Gong
- Division of Hematology/Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York
| | - William K. Oh
- Division of Hematology/Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York
| | - Simon J. Hall
- Department of Urology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York
| | - Cees J.M. van Rijn
- Centre for Bionanotechnology, University of Wageningen, Wageningenm, The Netherlands
| | - Matthew D. Galsky
- Division of Hematology/Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York
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Antoniewicz AA, Paziewska A, Mikula M, Goryca K, Dabrowska M, Poletajew S, Borowka A, Ostrowski J. Lack of evidence for increased level of circulating urothelial cells in the peripheral blood after transurethral resection of bladder tumors. Int Urol Nephrol 2011; 44:761-7. [PMID: 22160796 PMCID: PMC3358538 DOI: 10.1007/s11255-011-0102-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Aggressive intervention against the bladder wall during transurethral resection of bladder tumors (TURBT) causes damage and leakage from blood vessels to the bladder lumen. The aim of this study was to determine whether TURBT could increase the level of circulating urothelial cells. METHODS Expression of tumor markers, discriminative for nucleated blood cells and urothelium, was evaluated by quantitative (q) RT-PCR on RNA isolated from peripheral blood samples of 51 patients who underwent TURBT for ≥cT1c bladder tumors. RESULTS Four of 14 studied genes, epidermal growth factor receptor (EGFR), Collagen α-1(I) chain, Mast/stem cell growth factor receptor (KIT) and CD47, exhibited significant differences in gene expression between controls and cancer patients. While TURBT did not significantly increase the number of PCR-positive results of any transcripts, positive RT-PCR detection for EGFR was significantly less frequent on day 30 compared to results obtained before surgery. CONCLUSIONS Although the results of our study do not provide evidence for increased tumor cell release into the peripheral blood after TURBT, they seem to indicate that EGFR mRNA measurement in the blood may provide useful information for urologists.
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Affiliation(s)
- Artur A Antoniewicz
- Department of Urology, Medical Center for Postgraduate Education, Warsaw, Poland
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Utility of urothelial mRNA markers in blood for staging and monitoring bladder cancer. Urology 2011; 79:240.e9-15. [PMID: 22055693 DOI: 10.1016/j.urology.2011.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the efficiency of 6 mRNA bladder markers in staging urothelial cell carcinoma (UCC) and monitoring UCC dissemination from blood samples. METHODS From 2002 to 2009, 347 blood samples were collected from 150 patients with UCC and 29 healthy controls. Sequential blood sampling was performed in patients undergoing cystectomy at surgery and 6, 12, 18, and 24 months postoperatively. The median follow-up was 33 months. The presence of KRT20, FXYD3, C10orf116, UPK2, AGR2, and KRT19 markers in blood was evaluated in all patients and controls by measuring the gene expression using preamplified cDNA and reverse transcriptase quantitative polymerase chain reaction. Gene expression data were correlated with the tumor risk, follow-up, and outcomes data. RESULTS Expression of C10orf116 and KRT19 genes differed between patients and controls (P<.001). KRT20, C10orf116, and AGR2 differentiated between low- and high-risk nonmuscle-invasive bladder cancer (P=.001, P=.011, and P=.001, respectively). FXYD3 differentiated between patients with high-risk nonmuscle-invasive bladder cancer and those with muscle-invasive bladder cancer (P=.009). In contrast, the 6 markers showed no differences in gene expression between metastatic and patients without metastases who had not undergone cystectomy (P=NS). None of the markers were significantly increased in the metastatic patients at 6, 12, 18, or 24 months after surgery. CONCLUSION The gene expression of bladder-specific mRNA markers in blood was different among the various tumor risk groups of patients with UCC. However, this gene expression analysis is not suitable for predicting metastases or monitoring UCC hematogenous dissemination in patients who have undergone cystectomy.
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Behbakht K, Sill MW, Darcy KM, Rubin SC, Mannel RS, Waggoner S, Schilder RJ, Cai KQ, Godwin AK, Alpaugh RK. Phase II trial of the mTOR inhibitor, temsirolimus and evaluation of circulating tumor cells and tumor biomarkers in persistent and recurrent epithelial ovarian and primary peritoneal malignancies: a Gynecologic Oncology Group study. Gynecol Oncol 2011; 123:19-26. [PMID: 21752435 PMCID: PMC3336961 DOI: 10.1016/j.ygyno.2011.06.022] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/13/2011] [Accepted: 06/16/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with persistent/recurrent epithelial ovarian cancer/primary peritoneal cancer (EOC/PPC) have limited treatment options. AKT and PI3K pathway activation is common in EOC/PPC, resulting in constitutive activation of downstream mTOR. The GOG conducted a phase II evaluation of efficacy and safety for the mTOR inhibitor, temsirolimus in EOC/PPC and explored circulating tumor cells (CTC) and AKT/mTOR/downstream tumor markers. METHODS Eligible women with measurable, persistent/recurrent EOC/PPC who had received 1-3 prior regimens were treated with 25mg weekly IV temsirolimus until progression or intolerable toxicity. Primary endpoints were progression-free survival (PFS) ≥6-months, tumor response, and toxicity. CellSearch® system was used to examine CTC, and AKT/mTOR/downstream markers were evaluated by archival tumor immunohistochemistry. Kendall's tau-b correlation coefficient (r) and Cox regression modeling were used to explore marker associations with baseline characteristics and outcome. RESULTS Sixty patients were enrolled in a two-stage sequential design. Of 54 eligible and evaluable patients, 24.1% (90% CI 14.9%-38.6%) had PFS ≥6 months (median 3.1 months), 9.3% (90% CI 3.7%-23.4%) experienced a partial response. Grade 3/4 adverse events included metabolic (8), gastrointestinal (8), pain (6), constitutional (5) and pulmonary (4). Suggested associations were between cyclin D1 and PFS ≥6 months, PFS or survival; positive CTC pre-treatment and lack of response; and high CTC expression of M30 and PFS ≥6 months/longer PFS. CONCLUSIONS Temsirolimus appears to have modest activity in persistent/recurrent EOC/PPC; however, PFS is just below that required to warrant inclusion in phase III studies in unselected patients. Cyclin D1 as a selection marker and CTC measures merit further study.
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Affiliation(s)
| | - Michael W. Sill
- GOG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
- Department of Biostatistics, SUNY at Buffalo, Buffalo, NY
| | - Kathleen M. Darcy
- GOG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | - Russell J. Schilder
- Department of Pathology and Laboratory Medicine, the University of Kansas Medical Center, Kansas City, KS
| | - Kathy Q. Cai
- Department of Pathology and Laboratory Medicine, the University of Kansas Medical Center, Kansas City, KS
| | - Andrew K. Godwin
- Protocol Support Laboratory, Fox Chase Cancer Center, Philadelphia, PA
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Msaouel P, Koutsilieris M. Diagnostic value of circulating tumor cell detection in bladder and urothelial cancer: systematic review and meta-analysis. BMC Cancer 2011; 11:336. [PMID: 21816094 PMCID: PMC3161042 DOI: 10.1186/1471-2407-11-336] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/04/2011] [Indexed: 12/16/2022] Open
Abstract
Background The diagnostic value and prognostic significance of circulating tumor cell (CTC) detection in patients with bladder cancer is controversial. We performed a meta-analysis to consolidate current evidence regarding the use of CTC detection assays to diagnose bladder and other urothelial cancers and the association of CTC positivity with advanced, remote disease. Methods Studies that investigated the presence of CTCs in the peripheral blood of patients with bladder cancer and/or urothelial cancer were identified and reviewed. Sensitivities, specificities, and positive (LR+) and negative likelihood ratios (LR-) of CTC detection in individual studies were calculated and meta-analyzed by random effects model. Overall odds ratio of CTC positivity in patients with advanced disease versus those with organ-confined cancer was also calculated. Results Overall sensitivity of CTC detection assays was 35.1% (95%CI, 32.4-38%); specificity, LR+, and LR- was 89.4% (95%CI, 87.2-91.3%), 3.77 (95%CI, 1.95-7.30) and 0.72 (95%CI, 0.64-0.81). CTC-positive patients were significantly more likely to have advanced (stage III-IV) disease compared with CTC-negative patients (OR, 5.05; 95%CI, 2.49-10.26). Conclusions CTC evaluation can confirm tumor diagnosis and identify patients with advanced bladder cancer. However, due to the low overall sensitivity, CTC detection assays should not be used as initial screening tests.
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Affiliation(s)
- Pavlos Msaouel
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, 75 Micras Asias str., Goudi-Athens 115 27, Greece.
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Sun YF, Yang XR, Zhou J, Qiu SJ, Fan J, Xu Y. Circulating tumor cells: advances in detection methods, biological issues, and clinical relevance. J Cancer Res Clin Oncol 2011; 137:1151-1173. [PMID: 21681690 DOI: 10.1007/s00432-011-0988-y] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/26/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Circulating tumor cells (CTCs) have long been considered a reflection of tumor aggressiveness. Hematogenous spreading of CTCs from a primary tumor is a crucial step in the metastasis cascade, which leads ultimately to the formation of overt metastases. However, owing to the rarity of CTCs in peripheral blood, detecting these cells requires methods combined with high sensitivity and specificity, which sets tremendous challenges for the implementation of these assays into clinical routine. METHODS Generally, CTCs detection methods are composed of the following two steps: enrichment (isolation) process (morphological and immunological techniques) and detection (identification) process (cytometric and nucleic acid techniques), which may or may not be separate from enrichment. Genetic and molecular characterization of CTCs carried out by fluorescent in situ hybridization (FISH), comparative genomic hybridization (CGH), PCR-based techniques, and biomarker immunofluorescent staining extract more information about malignant profile, metastatic potential of CTCs, and the extent to which CTCs are genetically identical to the primary tumor. RESULTS Recent technical advances made it possible to detect CTCs. The efficacy of circulating tumor cell (CTC) detection among patients with solid malignancy has been investigated, which shows great potential to become a tool for real-time parameter of prognosis and serve as an early marker to assess the therapeutic response in overt cancers. Improvements in detection and characterization of CTCs will hopefully lead to refinement of clinical management of cancer patients. CONCLUSION This review addresses the majority of assays that have been published thus far, including the enrichment and detection steps and the markers used in these assays, accompanied by some biological issues of CTC and the results of clinical application harvested.
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Affiliation(s)
- Yun-Fan Sun
- Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Liver Cancer Institute, Zhong Shan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People's Republic of China
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Methods for the discovery of low-abundance biomarkers for urinary bladder cancer in biological fluids. Bioanalysis 2011; 2:295-309. [PMID: 21083311 DOI: 10.4155/bio.09.174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
For the study of bladder cancer and the identification of respective tumor markers, blood and, in particular, urine constitute suitable sources of biological material, while both harboring their specific challenges for analytics concerning low-abundance biomarkers. Dissolved proteins and nucleic acids as well as cells and cell-bound molecules can be the analytes. In urine, exfoliated bladder tumor cells have to be identified and in blood, circulating tumor cells have to be detected among huge amounts of other cells. For the detection of both low-abundance cells and molecules, their specific enrichment prior to analysis is advantageous or even necessary. Adapted methods for the analysis of proteomes and subproteomes by 2D-gel electrophoresis, multidimensional chromatography and antibody arrays are discussed. Analysis of nucleic acid-based markers exploits the high amplification power of PCR and modified PCR combined with previous (subtransciptomes) or subsequent (microarray) enrichment to sensitively and specifically detect markers. DNA mutations, DNA-methylation status and apoptotic DNA fragments, as well as levels of ribonucleic acids including microRNAs, can be analyzed by means of these methods. Finally, the challenge of identifying circulating tumor cells and assigning them to their original tissue is critically discussed.
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Reply by the Authors. Urology 2011. [DOI: 10.1016/j.urology.2010.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Retz M, Rotering J, Nawroth R, Buchner A, Stöckle M, Gschwend JE, Lehmann J. Long-term follow-up of bladder cancer patients with disseminated tumour cells in bone marrow. Eur Urol 2010; 60:231-8. [PMID: 21190793 DOI: 10.1016/j.eururo.2010.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/10/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical relevance of polymerase chain reaction (PCR)-based techniques for detection of disseminated tumour cells (DTCs) in the bone marrow of bladder cancer (BCa) patients is still under debate, as data on long-term follow-up analysis have not yet been published. OBJECTIVE The aim of the present prospective study was to assess the prognostic significance of DTCs detected by cytokeratin-20 (CK20) reverse-transcriptase PCR in bone marrow from BCa patients undergoing radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS Bone marrow samples from 51 BCa patients with high-risk non-muscle-invasive or muscle-invasive urothelial carcinoma were drawn from the anterior iliac crest prior to RC. CK20-positive cells in bone marrow were detected by qualitative RT-PCR. MEASUREMENTS BCa patients with CK20 status were analysed with respect to the end points tumour progression and cancer death. A multivariate Cox regression analysis was performed to determine independent prognostic factors for progression-free survival (PFS), tumour-specific survival (TSS), and overall survival (OS). RESULTS AND LIMITATIONS CK20-positive cells were detected in 16 of 51 (31.4%) BCa patients of all stages. BCa patients with CK20-negative status displayed a 7-yr PFS rate of 64% versus 35.2% for CK20-positive patients (p=0.007). TSS was significantly shorter in the CK20-positive group, with a 7-yr survival rate of 46.9% compared to CK20-negative patients with 70.2% (p=0.012). The 7-yr OS rate of 37.5% for CK20-positive patients was significantly <65.7% in the CK20-negative group (p=0.006). A subgroup analysis of lymph node-negative patients (pN0) discriminated by CK20 status revealed significant differences in PFS, TSS, and OS. In a multivariate analysis, CK20-status provides independent prognostic information with respect to all three survival end points. CONCLUSIONS BCa patients with positive CK20 status in bone marrow represent a high-risk subgroup reflected by an unfavourable outcome in the long-term analysis.
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Affiliation(s)
- Margitta Retz
- Department of Urology, Technische Universität München, Rechts der Isar Medical Centre, Munich, Germany.
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Tsouma A, Aggeli C, Lembessis P, Zografos GN, Korkolis DP, Pectasides D, Skondra M, Pissimissis N, Tzonou A, Koutsilieris M. Multiplex RT-PCR-based detections of CEA, CK20 and EGFR in colorectal cancer patients. World J Gastroenterol 2010; 16:5965-74. [PMID: 21157973 PMCID: PMC3007112 DOI: 10.3748/wjg.v16.i47.5965] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a multiplex reverse transcription polymerase chain reaction (RT-PCR) method detecting circulating tumor cells in the peripheral blood of colorectal cancer (CRC) patients.
METHODS: Peripheral blood samples were collected from 88 CRC patients and 40 healthy individuals from the blood donors’ clinic and subsequently analyzed by multiplex RT-RCR for the expression of carcinoembryonic antigen (CEA), cytokeratin 20 (CK20) and epidermal growth factor receptor (EGFR) mRNA. The analysis involved determining the detection rates of CEA, CK20 and EGFR transcripts vs disease stage and overall survival. Median follow-up period was 19 mo (range 8-28 mo).
RESULTS: Rates of CEA, CK20 and EGFR detection in CRC patients were 95.5%, 78.4% and 19.3%, respectively. CEA transcripts were detected in 3 healthy volunteer samples (7.5%), whereas all control samples were tested negative for CK20 and EGFR transcripts. The increasing number of positive detections for CEA, CK20 and EGFR transcripts in each blood sample was positively correlated with Astler-Coller disease stage (P < 0.001) and preoperative serum levels of CEA (P = 0.029) in CRC patients. Data analysis using Kaplan-Meier estimator documented significant differences in the overall survival of the different CRC patient groups as formed according to the increasing number of positivity for CEA, CK20 and EGFR transcripts.
CONCLUSION: These data suggest that multiplex RT-PCR assay can provide useful information concerning disease stage and overall survival of CRC patients.
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Rink M, Chun FKH, Minner S, Friedrich M, Mauermann O, Heinzer H, Huland H, Fisch M, Pantel K, Riethdorf S. Detection of circulating tumour cells in peripheral blood of patients with advanced non-metastatic bladder cancer. BJU Int 2010; 107:1668-75. [PMID: 20735381 DOI: 10.1111/j.1464-410x.2010.09562.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE • To prospectively detect and evaluate the biological significance of circulating tumour cells (CTC) in patients with bladder cancer, especially in those patients with non-metastatic, advanced bladder cancer (NMABC). PATIENTS AND METHODS • Between July 2007 and January 2009, blood samples of 50 consecutive patients with localized bladder cancer and five patients with metastatic disease scheduled for cystectomy were prospectively investigated for CTC. Peripheral blood (7.5 ml) was drawn before cystectomy. • Detection of CTC was performed using the USA Food and Drug Administration-approved CellSearch(TM) system. Data were compared with the clinical and histopathological findings. RESULTS • CTC were detected in 15 of 50 patients (30%) with non-metastatic disease and five of five patients with metastatic disease. The overall mean number of CTC was 33.7 (range: 1-372; median: 2). In non-metastatic patients, the mean number of CTC was 3.1 (range: 1-11; median: 1). Except for a univariate association between CTC with vessel infiltration (P= 0.047), all other common clinical and histopathological parameters did not reveal a significant correlation with CTC detection. • A median 1-year follow up was available for 53 patients (96.4%). Ten out of 19 preoperatively CTC-positive patients died as a result of cancer progression. • CTC-positive patients showed significantly worse overall (P = 0.001), progression-free (P < 0.001) and cancer specific survival (P < 0.001) compared to preoperatively CTC-negative patients. CONCLUSION • This is the largest study demonstrating that detection of CTC in NMABC patients is feasible using the CellSearch(TM) system. Our findings suggest that the presence of CTC may be predictive for early systemic disease.
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Affiliation(s)
- Michael Rink
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
Circulating tumor cells (CTCs) are defined as cells that have detached, spontaneously or as a result of clinical operations, from a primary tumor or its metastatic lesions and circulate in the peripheral blood. They are considered as the primary reason for postoperative recurrence and distant metastasis of malignant tumors. In recent years, non-invasive detection of circulating tumor cells has become a new type of diagnostic tool to evaluate postoperative recurrence, distant metastasis, and prognosis. This article reviews recent advances in research on circulating tumor cells.
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