Circulating tumor cells in early stage lung adenocarcinoma: a case series report and literature review
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Xu-Rui Jin1,*, Lu-Yao Zhu1,*, Kai Qian1, Yong-Geng Feng1, Jing-Hai Zhou1, Ru-Wen Wang1, Li Bai2, Bo Deng1, Naixin Liang3, Qun-You Tan1
1Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
2Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
3Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
*These authors contributed equally to this work
Bo Deng, email: firstname.lastname@example.org
Naixin Liang, email: email@example.com
Qun-You Tan, email: firstname.lastname@example.org
Keywords: lung adenocarcinoma, circulating tumor cells, AIS, EMT
Received: September 14, 2016 Accepted: February 08, 2017 Published: February 19, 2017
Purpose: The study aimed to monitor circulating tumor cells (CTCs) in early stage lung adenocarcinoma patients.
Results: CTCs were characterized and classified to epithelial (E-) CTCs, mesenchymal (M-) CTCs and epithelial- mesenchymal (E&M-) CTCs, as per epithelial-mesenchymal transition(EMT) biomarkers. CTCs could not be found in healthy controls. However, in cohort A, CTCs were found in 17 (17/18) cases. Detection rate of E-CTCs was lower (5/18) compared with M-CTC (10/18) or E&M-CTC (14/18). Highly abundant M-CTCs were prone to being in the tumors > 2 cm. In cohorts A and B, CTCs count increased significantly in all patients with tumor progression (7/7). Higher CTCs level or change range could be found postoperatively in the patients with tumor progression, as compared with patients with disease free survival (P < 0.01). Additionally, CTCs detected by CanPatrolTM could be validated by CytoploRare or Pep@MNPs.
Materials and Methods: We included four cohorts of patients and 20 healthy controls. In cohort A, CTCs were detected by a newly established approach, i.e., CanPatrolTM, prior to anesthesia and monitored after operation longitudinally. In cohort B, CTCs were not assessed prior to operation, but were longitudinally detected after operation. For validation, we detected FOLR(+)-CTCs by using CytoploRare and EPCAM(+)-CTCs by using Pep@MNPs prior to operation, in cohorts C and D, respectively.
Conclusion: CTCs can be detected in early stage lung adenocarcinoma, even in adenocarcinoma in situ, and CTCs detection can effectively monitor tumor progression. The distinguishing of biomarkers of highly invasive and aggressive CTCs warrants further robust study.
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