網上肝癌風險計數機
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1.6 乳癌看數據
看數據: CTC vs. 傳統癌症指數(CEA, CA153)更能預測療效?
歐洲一個聯合臨床研究, 綜合了17個癌症中心的數據, 為期九年, 分析了1944個晚期乳癌患者, 發現治療前和治療後的CTC數量改變與生存期有顯著關係, CTC數量的改變能預測療效。在治療前, 1944個患者中的1029個患者沒有CTC (53%)。研究發現, 在開始治療後的第3至5週(大概一至兩個週期的治療), 如果患者的CTC增多, 他們的死亡率比較高, 死亡風險比率是沒有CTC增多的患者的2.26倍(harzard ratio=2.26)。如果治療後第6至8週CTC增多, 患者的死亡風險率是沒有CTC增多的患者的2.91倍。研究人員同時比較傳統癌症指數CEA, CA153, 如果患者治療後CEA, CA153增多, 死亡風險率只有些微增多 - 是沒有增多的患者的1.54-1.59倍。當研究人員再進一步把其他因素(例如患者腫瘤的分期, 分類, 治療病史, 癌症擴散數據)作分析, 去建立一個臨床病理模型, 從而預測療效及生存期, 發現癌症指數(CEA, CA153) 無助於改善預測, CTC對預測療效有顯著幫助(p<0.0001)。研究證實CTC是傳統檢測的有力輔助 , CTC比傳統癌症指數CEA/CA153更能反映生存期。
References:
Clinical validity of circulating tumour cells in patients with metastatic breast cancer: a pooled analysis of individual patient data.Lancet Oncol. 2014 Apr;15(4):406-14. doi: 10.1016/S1470-2045(14)70069-5. Epub 2014 Mar 11.
以下是更多的乳癌CTC文獻:
*無進展存活期 = PFS
*無病存活期 = DFS
*總存活期 = OS
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硏究國家 | 癌症類型 | 硏究病例 | 結論 | 文獻參考 |
|---|---|---|---|---|
非轉移性乳癌 | 302 | 手術前CTC的存在可預測早期復發; CTC的存在預測較短的患者PFS和OS | 1 | |
非轉移性乳癌 | 2026 | 化療前後若CTC存在, 患者的DFS和OS更差 | 2 | |
非轉移性乳癌 | 3173 | CTC的存在可靠地識別存活率較低的早期乳腺癌患者 | 3 | |
非轉移性乳癌+轉移性乳癌 | 6825 | 早期乳腺癌患者中, CTC的存在預測較低DFS; 晚期乳腺癌患者中, CTC的存在預測較低PFS | 4 | |
轉移性乳癌 | 492 | 較高CTC的患者有較多的轉移腫瘤，及較快發生腫瘤轉移 | 5 | |
轉移性乳癌 | 393 | 若患者在治療前後持續發現CTC或CTC增多, 患者的PFS和OS會較短 | 6 | |
轉移性乳癌 | 177 | 在隨訪跟進期間, 若患者具有較高CTC, 患者會有更短的PFS和OS | 7 | |
轉移性乳癌 | 159 | CTC數目的增加與骨轉移的發生有關 | 8 | |
轉移性乳癌 | 59 | CTC數目的增加與骨轉移的發生有關 | 9 |
References
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A. Lucci et al., Circulating tumour cells in non-metastatic breast cancer: a prospective study. The Lancet. Oncology 13, 688-695 (2012).
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B. Rack et al., Circulating tumor cells predict survival in early average-to-high risk breast cancer patients. Journal of the National Cancer Institute 106, (2014).
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W. J. Janni et al., Pooled Analysis of the Prognostic Relevance of Circulating Tumor Cells in Primary Breast Cancer. Clinical cancer research : an official journal of the American Association for Cancer Research 22, 2583-2593 (2016).
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L. Zhang et al., Meta-analysis of the prognostic value of circulating tumor cells in breast cancer. Clinical cancer research : an official journal of the American Association for Cancer Research 18, 5701-5710 (2012).
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M. Giuliano et al., Circulating tumor cells as early predictors of metastatic spread in breast cancer patients with limited metastatic dissemination. Breast cancer research : BCR 16, 440 (2014).
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D. F. Hayes et al., Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival. Clinical cancer research : an official journal of the American Association for Cancer Research 12, 4218-4224 (2006).
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M. Wallwiener et al., Serial enumeration of circulating tumor cells predicts treatment response and prognosis in metastatic breast cancer: a prospective study in 393 patients. BMC cancer 14, 512 (2014).
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U. De Giorgi et al., Circulating tumor cells and bone metastases as detected by FDG-PET/CT in patients with metastatic breast cancer. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO 21, 33-39 (2010).
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M. Bulfoni et al., In patients with metastatic breast cancer the identification of circulating tumor cells in epithelial-to-mesenchymal transition is associated with a poor prognosis. Breast cancer research : BCR 18, 30 (2016).
