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Year : 2020  |  Volume : 5  |  Issue : 3  |  Page : 241-247

The role of circulating tumor cells as a prognostic marker in the adjuvant setting of patients with breast cancer

1 Department of Clinical Oncology, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
2 Department of Clinical Pathology, South Egypt Cancer Institute, Assiut, Egypt

Correspondence Address:
Summar Elmorshidy
Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCMRP.JCMRP_144_18

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Background Still, there is no clinically reliable marker to detect micrometastasis or breast cancer relapse. This study aimed to evaluate the role of circulating tumor cells (CTCs) as a biomarker in patients with nonmetastatic breast cancer. Patients and methods CTC quantification was carried out using flow cytometry for 50 patients with breast cancer postoperatively: before starting, after three cycles, and at the end of adjuvant chemotherapy. The relationship between CTCs and other tumor characteristics and outcomes were studied. Results The median follow-up duration was 35 months. Before starting adjuvant chemotherapy, CTCs were positive (cutoff point ≥5/7.5 ml) in 36% of the patients and decreased to 20% after finishing chemotherapy (P = 0.04). CTCs were detected in 88.9% (n = 16 of 18) of node-positive patients and in 11.1% of node-negative patients (n = 2 of 18, P = 0.04). No significant association was found with tumor size, grading, or hormone receptor status. Distant metastasis was detected in 20% (n = 10 of 50) of patients and was significantly associated with CTCs more than or equal to 5 in 80% of them (n = 8 of 10) (P = 0.01). The presence of more than or equal to 5 CTCs at baseline was associated with a reduction in both the disease-free survival and overall survival (P < 0.001 and P = 0.003, respectively). Baseline CTCs more than or equal to 5/7.5 ml were confirmed as an independent prognostic factor in multivariate Cox hazard regression analysis for disease-free survival (hazard ratio = 3.71; 95% confidence interval = 1.62–8.48; P = 0.002) and overall survival (hazard ratio = 3.14; 95% confidence interval = 1.34–7.37; P = 0.009). Conclusions The current work suggested that the presence of more than or equal to 5 CTCs/7.5 ml at baseline would predict early disease recurrence and reduce the overall survival in patients with nonmetastatic breast cancer receiving adjuvant chemotherapy.

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