Application Of Circulating Tumor Cell Detection In The Evaluation Of Neoadjuvant Chemotherapy Therapeutic Effect For Breast Cancer

ObjectiveTo evaluate the effectiveness of isolation by size of epithelial tumor cell(ISET)in the detection of peripheral blood circulating tumor cell(CTC)in patients with breast cancer.To explore the relationship between circulating tumor cell(CTC)in peripheral blood of breast cancer patients and the curative effect of neoadjuvant chemotherapy for breast cancer.MethodsTotally 94 breast cancer patients in Department of Breast and Thyroid Surgery,Research Institute of Surgery,Daping Hospital,Third Military Medical University,from December 2014 to June 2016 were enrolled for a prospective study according to the inclusion and exclusion criteria.Venous blood samples of 5 ml was collected from upper limb in healthy side of patients before and after neoadjuvant chemotherapy(NAC),and isolation by size of epithelial tumor cell(ISET)was adopted in detecting circulating tumor cells in peripheral blood.Conventional imaging examination was given before the first chemotherapy and after 2-4 cycles of NAC to evaluate the curative effect of NAC according to Response Evaluation Criteria in Solid Tumors(RECIST guideline version).If the chemotherapy was ineffective,the patients shifted to surgical treatment,otherwise,the patients completed 6 cycles of NAC and then underwent surgical treatment.According to pathological evaluation standard of Miller-Payne as a gold standard for curative effect evaluation,CTC reduction was defined as effective and CTC invariant or increase was defined as ineffective by the changes of CTC number after NAC.? 2 test was used to analyze the association between the presence of CTC and clinicopathological characteristics of breast cancer patients.McNemar test was used to compare the positive rate of CTC before and after NAC.The number of CTC before and after treatment were expressed as Md(P25,P75)because of its skewed distribution,and compared using Wilcoxonsigned-rank test.Kappa test and Mc Nemar test were used to evaluate the consistency between CTC detection and pathological gold standard.The sensitivity and specificity were calculated to evaluate the CTC detection.ResultsThe detection rate of CTC in peripheral blood before NAC was 62.8%(59/94).which was related to the expression of patients with HER-2(?2=10.971,P=0.001)and Ki67(?2=11.072,P=0.001).The positive rate of CTC(?2=35.100,P<0.001)and detected number(Z=-6.120,P<0.001)before and after NAC were all significantly different.According to the pathological standard of Miller-Payne as a gold standard,the specificity of CTC detection in NAC efficacy evaluation was 69.8 %(30/43)and the sensitivity was76.5%(39/51),the evaluation results of the evaluation method was consistent with the gold standard,the strength of the agreement based on the Kappa coefficient was described as moderate(Kappa=0.463,P<0.001).ConclusionISET method can effectively detect CTC in peripheral blood of patients with breast cancer.The alteration of CTC after NAC is related to the curative effect of NAC.CTC detection has the potential to become a new way to assess the efficacy of NAC.