目前,人们对循环肿瘤细胞(CTC)的表型,特别是上皮和间质表型及其对结直肠癌(CRC)患者预后的影响知之甚少。本研究旨在调查 III/IV 期 CRC 中的 CTC 表型及其预后意义。纳入了被诊断为 CRC 并在两家医院接受 CTC 检测的患者。采用间充质CTC试剂盒检测CTC,并将CTC与细胞表面波形蛋白阳性CTC(CSV-CTC)的临床和病理特征进行比较。评估无病生存率 (DFS) 并将其用作 CTC 表型相关预后的指标。进行单变量和多变量 Cox 回归分析以确定危险因素,并采用列线图模型进行预后预测。共入组82例患者,CTC检出率为86.6%。在检测到的 CTC 中,60% 是 CSV-CTC。 CSV-CTC计数与T分期、M分期和原发肿瘤位置呈正相关(分别为P = 0.01、P = 0.014和P = 0.01)。 Kaplan-Meier 生存分析显示,在接受一线奥沙利铂化疗的患者中,CSV-CTC 与较差的 DFS 相关(风险比 (HR) = 3.78,95% CI 1.55–9.26,p = 0.04)。当CSV-CTC计数的截止值为3时,实现了最佳预后预测。考虑 CSV-CTC、TNM 分期、原发肿瘤部位和 Ras 基因状态的复合模型在接受者操作特征 (ROC) 分析和决策曲线分析 (DCA) 中均产生了最佳结果。 本研究表明,CRC患者的CTC以CSV-CTC为主,且CSV-CTC计数≥3是预后较差的独立危险因素。
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Evaluation of cell surface vimentin positive circulating tumor cells as a prognostic biomarker for stage III/IV colorectal cancer
Currently, little is known about the phenotypes of circulating tumor cells (CTCs), particularly epithelial and mesenchymal phenotypes, and their impact on the prognosis of colorectal cancer (CRC) patients. This study aims to investigate the CTC phenotypes and their prognostic implications in stage III/IV CRC. Patients who were diagnosed with CRC and underwent CTC detection at two hospitals were included. CTCs were detected using a mesenchymal CTC kit, and the clinical and pathological characteristics of CTCs were compared with those of cell surface vimentin-positive CTCs (CSV-CTCs). Disease-free survival (DFS) was assessed and used as an indicator of CTC phenotype-related prognosis. Univariate and multivariate Cox regression analyses were made to identify risk factors, and nomogram models were employed for prognostic prediction. A total of 82 patients were enrolled, with a CTC detection rate of 86.6%. Among the detected CTCs, 60% were CSV-CTCs. The CSV-CTC count showed a positive correlation with the T-stage, the M-stage, and the location of the primary tumor (P = 0.01, P = 0.014, and P = 0.01, respectively). Kaplan–Meier survival analysis revealed that CSV-CTCs were associated with worse DFS in patients receiving first-line oxaliplatin chemotherapy (hazard ratio (HR) = 3.78, 95% CI 1.55–9.26, p = 0.04). When the cut-off value of the CSV-CTC count was 3, the optimal prognostic prediction was achieved. Compound models considering CSV-CTCs, TNM staging, the site of the primary tumor and the Ras gene status yielded the best results in both the receiver operating characteristic (ROC) analysis and the decision curve analysis (DCA). This study indicates that CSV-CTCs predominate in CTCs of CRC patients, and a count of CSV-CTCs ≥ 3 is an independent risk factor for worse prognosis.