Circulating Tumor Cells: What Goes Around, Comes Around
Menée à partir d'échantillons sanguins prélevés sur 2 026 patientes atteintes d'un cancer du sein de stade précoce à risque intermédiaire ou élevé de récidive (durée médiane de suivi : 35 mois), cette étude met en évidence une association entre le nombre de cellules tumorales circulantes, mesuré avant ou après une chimiothérapie adjuvante, et la survie des patientes
When invasive tumors are merely a few millimeters, they have the capacity to infiltrate normal tissue, create a reactive stroma, and generate a neovascular response. The tumor neovascularization creates an angiogenic support for cellular proliferation and vascular entry that leads to tumor dissemination. Despite excision of the primary neoplastic mass, residual tumor cells remain occult to physical or radiologic examination or serologic testing until recurrent malignancy is later identified in a metastatic site (1). These isolated tumor cells may have invaded the lympho-vascular system as circulating tumor cells (CTCs) or achieved an isolated tumor focus designated as disseminated tumor cells (DTCs), possibly detected in a bone marrow biopsy (2–4). Occult malignancy or minimal residual disease is thought to be the source of cancer relapse in patients whose postsurgical status represents no evidence of disease. Given that hematogenous metastases occur through a complex biologic pathway of vascular invasion, circulation, identification of a favorable metastatic site, and clonal expansion, it appears intuitive that identification of the leukemic phase of CTCs in peripheral blood or the deposition phase of DTCs in vascular-rich environments may be prognostic for tumor recurrence and metastasis.
Journal of the National Cancer Institute , éditorial, 2014