Detection of circulating tumor cells for prediction of recurrence after adjuvant chemoradiation in locally advanced squamous cell carcinoma of the head and neck
Menée à partir d'échantillons sanguins prélevés sur 144 patients atteints d'un carcinome épidermoïde de la tête et du cou de stade localement avancé et traités par résection, cette étude évalue l'intérêt de détecter, après l'opération, des cellules tumorales circulantes pour prédire le risque de récidive après une chimioradiothérapie adjuvante
Background : The prognostic role of persistence of circulating tumor cells (CTC) after upfront tumor surgery for outcome of adjuvant (chemo)radiation in locally advanced squamous cell carcinoma of the head and neck (LASCCHN) was evaluated.
Patients and methods : In this prospective study, peripheral blood samples from 144 patients with LASCCHN presenting after tumor resection for adjuvant treatment were analysed for CTC. Their detection was correlated with tumor site, clinical risk factors, disease-free (DFS) and overall survival (OS).
Results : CTC were detected in 42 of 144 patients (29%). CTC detection was higher in cases with nodal involvement and in carcinomas located at the tonsil or base of tongue but was not influenced by age, smoking history, T stage, extracapsular extension (ECE), surgical margins or the HPV status. Overall, the presence of CTC was not predictive for OS or DFS. However, while in oropharyngeal carcinomas (OPC, n=63) detection of CTC was associated per trend with improved DFS (CTC+ vs CTC- [% of patients without evidence of disease at 2 years]: 100% vs. 79%; log-rank: p=0.059) the reverse was observed for carcinomas from other sites (non-OPC, n=81; CTC+ vs. CTC-: 29% vs. 75%; p=0.001). In multivariate analysis, CTC remained an independent prognostic marker for DFS (HR 4.3, 95% CI 1.7-10.9, p=0.002) and OS (HR 2.7, 95% CI 1.2-6.3, p=0.016) in non-OPC.
Conclusions : Assessment of CTC in non-OPC should prove useful for identification of patients who benefit from treatment intensification. The basis for the good prognostic value of CTC in OPC has to be elucidated in future studies.
Annals of Oncology , résumé, 2014