The Role Of CTCs And EMT Phenotype Identification Of CTCs In NSCLC Staging And Efficacy Evaluation

ObjectiveThe purpose is to study the role of epithelial circulating tumor cells(CTCs),biophenotypic(epithelial/mesenchymal)CTCs,mesenchymal CTCs in non-small cell lung cancer(NSCLC)TNM staging,and to investigate the value of EMT phenotype identification of CTCs in patients with lung adenocarcinoma receiving chemotherapy.Methods1.A total of 26 persons with NSCLSC were enrolled in this study.The epithelial CTCs,biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs were detected by CanPatrolTM;2.A total of 23 cases with lung adenocarcinoma were included.The epithelial CTCs,biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs were analyzed at baseline and after two cycles of chemotherapy.Meanwhile,the tumors were monitored by computed tomography every 2 chemotherapy cycles(6 weeks).Results1.Our data indicated that the biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs were closely correlated with M staging(P<0.05),and there was no significant correlation between the biophenotypic(epithelial/mesenchymal)CTCs,mesenchymal CTCs and other clinicopathological factors,such as age,sex,smoking,T staging and N staging(P > 0.05,respectively);there was no significant correlation between epithelial CTCs and clinicopathological factors,such as age,sex,smoking,T staging,N staging and M staging(P>0.05,respectively);2.For predicting M staging in NSCLC,biophenotypic(epithelial/mesenchymal)CTCs yielded an area under the curve of 0.819,with sensitivity reaching 61.9% and specificity reaching 100.0%;mesenchymal CTCs yielded an area under the curve of 0.833,with sensitivity reaching 76.19% and specificity reaching 80.0%;biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs yielded an area under the curve of 0.914,with sensitivity reaching 85.71% and specificity reaching 80.0%;3.The number of biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs after two cycle of chemotherapy(1.0(1.0,4.0)count/5ml,1.0(0.0,1.0)count/5ml,respectively)in the subgroup of DCR patients were was lower than that of befoer chemotherapy(3.0(2.0,11.0)count/5ml,2.0(1.0,7.0)count/5ml,respectively,P<0.05),there was no significant difference between the number of epithelial CTCs after two cycle of chemotherapy and the number of epithelial CTCs before chemotherapy(P(29)0.05)in the subgroup of DCR patients;conversely,the number of biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs after two cycle of chemotherapy(5.5(2.75,9.5)count/5ml,1.5(0.0,5.25)count/5ml,respectively)in the subgroup of PD patients were was higher than that of befoer chemotherapy(1.0(0.0,2.25)count/5ml,1.0(0.0,1.0)count/5ml,respectively,P<0.05),there was no significant difference between the number of epithelial CTCs after two cycle of chemotherapy and the number of epithelial CTCs before chemotherapy(P(29)0.05)in the subgroup of PD patients;4.The consistency between CTCs detection and RECIST criteria in chemotherapy efficacy evaluation was highly consistent(Kappa=0.913,P=0.000).Conclusions1.High level of biophenotypic(epithelial/mesenchymal)CTCs and mesenchymal CTCs were associated with higher M stage in NSCLC;2.CTCs could be used to evaluate the efficacy of chemotherapy for lung adenocarcinoma;...