Clinical significance of circulating tumor cells in predicting disease progression and chemotherapy resistance in patients with gestational choriocarcinoma

Abstract

Gestational choriocarcinoma (GC) is a highly aggressive tumor. In our study, we systematically investigated EpCAM/CD147 expression characteristics in patients with GC and assessed the role of circulating tumor cells (CTCs) in predicting chemotherapy response and disease progression. GC tissues were positive for either epithelial cellular adhesion molecule (EpCAM) or CD147, and all samples exhibited strong human chorionic gonadotropin (HCG) expression. Among all the recruited patients (n = 115), 103 had at least 1 CTC in a 7.5-mL peripheral blood sample, and the percentage of patients with ≥4 CTCs in a particular FIGO stage group increased with a higher FIGO stage (p < 0.001). Furthermore, the pretreatment CTC count was related to tumor size (r = 0.225, p = 0.015) and the number of metastases (r = 0.603, p < 0.001). A progression analysis showed that among the 115 included patients who qualified for further examination, 52 of the 64 patients defined as progressive had ≥4 pretreatment CTCs, while only 7 of the 51 non-progressive patients had ≥4 pretreatment CTCs (p < 0.001). In multivariate analysis, CTCs (≥4) remained the strongest predictor of PFS when other prognostic markers, FIGO score and FIGO stage were included. Moreover, based on the chemotherapy response, patients with ≥4 CTCs were more likely to be resistant to chemotherapy than those with <4 CTCs (P < 0.001). These findings demonstrates the feasibility of CTC detection in cases of GC by adopting EpCAM/CD147 antibodies together as capturing antibodies. The CTC count is a promising indicator in the evaluation of biological activities and the chemotherapy response in GC patients.

Fatty Acid Oxidation Controls CD8+ Tissue-Resident Memory T-cell Survival in Gastric Adenocarcinoma

“…Circulating tumor cells (CTC) were separated by the NanoVelcro system (Cytolumina) as previously described (20). A total amount of 5 ml blood specimens was collected from each of the patients with gastric adenocarcinoma, and the samples were processed within 24 hours.…”

The Role of Circulating Tumor Cells in the Metastatic Cascade: Biology, Technical Challenges, and Clinical Relevance

“…In early stage prostate [159], breast [160] and lung cancer [161], the presence of more than five CTCs per 7.5 mL of peripheral blood is a strong predictor of PFS reduction, whereas the detection of fewer than five CTCs per 7.5 mL is predictive of better OS. In gestational choriocarcinoma, patients with a CTC count ≥4 are at higher risk of distant multiple-organ metastases, and of chemotherapy resistance [162]. CTC count increases with tumor progression and development of distant metastases [163].…”

“…CTCs may provide useful information for tumor staging at diagnosis. For instance, in gastric cancer, the percentage of patients with ≥4 CTCs increases with the tumor stage and reaches 95.24% at stage IV [162]. Moreover, CTC count ≥4 is associated with significantly higher risk of distant organ metastases [162].…”

“…For instance, in gastric cancer, the percentage of patients with ≥4 CTCs increases with the tumor stage and reaches 95.24% at stage IV [162]. Moreover, CTC count ≥4 is associated with significantly higher risk of distant organ metastases [162]. In the clinic, liquid biopsy for CTC detection/enumeration should be performed particularly in the period after diagnosis of the primary tumor and before the detection of metastatic lesions (i.e., "metastatic latency").…”

Research and application of single-cell sequencing in tumor heterogeneity and drug resistance of circulating tumor cells

“…Therefore, increasing studies are conducted on tumor resistance through CTC. Scholars study choriocarcinoma [ 22 ], colorectal cancer [ 23 – 26 ], liver cancer [ 27 ], lung cancer [ 28 , 29 ], breast cancer [ 30 , 31 ], lymphoma [ 32 ], gastric cancer [ 33 ] and other malignant tumors through CTC to explore the drug resistance of tumor cells. However, most current CTC analyses are based on CTC epithelial biomarkers, and epithelial biomarkers may not be expressed in several tumor types [ 34 ].…”