Peripheral arterial disease and systematic detection of circulating tumor cells: rationale and design of the DETECTOR prospective cohort study

Abstract

Background Smoking is a strong risk factor for cancer and atherosclerosis. Cancer mortality, especially from lung cancer, overtakes cardiovascular (CV) death rate in patients with peripheral arterial disease (PAD). Only a few patients with lung cancer after PAD management may benefit from surgical excision. Circulating tumor cells (CTC) associated with low-dose chest CT (LDCT) may improve early cancer detection. This study focuses on a screening strategy that can address not only lung cancer but all tobacco-related cancers in this high-risk population. Methods DETECTOR Project is a prospective cohort study in two French University hospitals. Participants are smokers or former smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 to 80 years, with atherosclerotic PAD or abdominal aortic aneurysm. After the first screening round combining LDCT and CTC search on a blood sample, two other screening rounds will be performed at one-year interval. Incidental lung nodule volume, volume doubling time and presence of CTC will be taken into consideration for adapted diagnostic management. In case of negative LDCT and presence of CTC, a contrast enhanced whole-body PET/CT will be performed for extra-pulmonary malignancy screening. Psychological impact of this screening strategy will be evaluated in population study using a qualitative methodology. Assuming 10% prevalence of smoking-associated cancer in the studied population, a total of at least 300 participants will be enrolled. Discussion Epidemiological data underline an increase incidence in cancer and related death in the follow-up of patients with PAD, compared with the general population, particularly for tobacco-related cancers. The clinical benefit of a special workup for neoplasms in patients with PAD and a history of cigarette smoking has never been investigated. By considering CTCs detection in this very high-risk selected PAD population for tobacco-induced cancer, we expect to detect earlier pulmonary and extra-pulmonary malignancies, at a potentially curable stage. Trial registration The study was registered in the French National Agency for Medicines and Health Products Safety (No N° EUDRACT_ID RCB: 2016-A00657–44) and was approved by the ethics Committee for Persons Protection (IRB number 1072 and n° initial agreement 2016-08-02; ClinicalTrials.gov identifier NCT02849041).

Association Between Obesity and Cancer Mortality: An Internal Medicine Outpatient Clinic Perspective

“…A similar report was published by Fiotti and associates, in which they found that the patients with PAD had a higher long-term mortality rate, and mortality rate from cancer exceeded that of cardiovascular diseases [ 57 ]. According to Yannoutsos and colleagues, and many other studies, the epidemiological evidence confirms that PAD is a marker for the development of lung cancer, independent of age [ 58 - 63 ]. Similarly, Kaschwich and colleagues found that patients suffering from symptomatic PAD had a markedly higher risk for incident cancer in the long-term follow-up, especially for certain types of cancers, such as cancer of the lung, bladder, pancreas, and colon [ 64 ].…”

Predictive Value of Folate Receptor‐Positive Circulating Tumor Cells for the Preoperative Diagnosis of Lymph Node Metastasis in Patients with Lung Adenocarcinoma

“…Smoking is considered a significant risk factor for cancer, while tumor size may reflect invasiveness, as was also found in other research. [ 18,19 ] In the subgroup analysis of LNM status, the average CTC level in the LNM‐positive subgroups was 12.10 (8.26–15.84) units, which was significantly higher than the average of 10.43 (7.91–13.37) units in the LNM‐negative subgroups. Surprisingly, nodal stage and the novel nodal classifications had strong correlations to CTC level, which supported our previous hypothesis and the results of the meta‐analysis above.…”