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Yu E, Allan AL, Sanatani M, Lewis D, Warner A, Dar AR, Yaremko BP, Lowes LE, Palma DA, Raphael J, Vincent MD, Rodrigues GB, Fortin D, Inculet RI, Frechette E, Bierer J, Law J, Younus J, Malthaner RA. Circulating tumor cells detected in follow-up predict survival outcomes in tri-modality management of advanced non-metastatic esophageal cancer: a secondary analysis of the QUINTETT randomized trial. BMC Cancer 2022; 22:746. [PMID: 35804307 PMCID: PMC9264673 DOI: 10.1186/s12885-022-09846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022] Open
Abstract
Background Our aim was to establish if presence of circulating tumor cells (CTCs) predicted worse outcome in patients with non-metastatic esophageal cancer undergoing tri-modality therapy. Methods We prospectively collected CTC data from patients with operable non-metastatic esophageal cancer from April 2009 to November 2016 enrolled in our QUINTETT esophageal cancer randomized trial (NCT00907543). Patients were randomized to receive either neoadjuvant cisplatin and 5-fluorouracil (5-FU) plus radiotherapy followed by surgical resection (Neoadjuvant) or adjuvant cisplatin, 5-FU, and epirubicin chemotherapy with concurrent extended volume radiotherapy following surgical resection (Adjuvant). CTCs were identified with the CellSearch® system before the initiation of any treatment (surgery or chemoradiotherapy) as well as at 6-, 12-, and 24-months post-treatment. The threshold for CTC positivity was one and the findings were correlated with patient prognosis. Results CTC data were available for 74 of 96 patients and identified in 27 patients (36.5%) at a median follow-up of 13.1months (interquartile range:6.8-24.1 months). Detection of CTCs at any follow-up visit was significantly predictive of worse disease-free survival (DFS;hazard ratio [HR]: 2.44; 95% confidence interval [CI]: 1.41-4.24; p=0.002), regional control (HR: 6.18; 95% CI: 1.18-32.35; p=0.031), distant control (HR: 2.93; 95% CI: 1.52-5.65;p=0.001) and overall survival (OS;HR: 2.02; 95% CI: 1.16-3.51; p=0.013). After adjusting for receiving neoadjuvant vs. adjuvant chemoradiotherapy, the presence of CTCs at any follow-up visit remained significantly predictive of worse OS ([HR]:2.02;95% [Cl]:1.16-3.51; p=0.013) and DFS (HR: 2.49;95% Cl: 1.43-4.33; p=0.001). Similarly, any observed increase in CTCs was significantly predictive of worse OS (HR: 3.14; 95% CI: 1.56-6.34; p=0.001) and DFS (HR: 3.34; 95% CI: 1.67-6.69; p<0.001). Conclusion The presence of CTCs in patients during follow-up after tri-modality therapy was associated with significantly poorer DFS and OS regardless of timing of chemoradiotherapy.
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Affiliation(s)
- Edward Yu
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada.
| | | | | | - Debra Lewis
- Thoracic Surgery and Surgical Oncology, London, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada
| | - A Rashid Dar
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada
| | - Brian P Yaremko
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada
| | - Lori E Lowes
- Pathology & laboratory medicine, London Health Science Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada
| | | | | | - George B Rodrigues
- Department of Oncology, Divisions of Radiation Oncology, Western University, 1151 Richmond Street, London, Ontario, N6A3K7, Canada
| | - Dalilah Fortin
- Thoracic Surgery and Surgical Oncology, London, Ontario, Canada
| | | | - Eric Frechette
- Department of Thoracic Surgery and Surgical Oncology, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Joel Bierer
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jeffery Law
- Department of Medicine, Western University, London, Ontario, Canada
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