title: Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: prognostic and predictive significance.
abstract: BACKGROUND
  We investigated the frequency of detection and the prognostic and predictive significance of circulating tumor cells (CTCs) in patients with recurrent/metastatic (R/M) head and neck carcinoma (HNC) before starting systemic therapy.
  
  
  METHODS
  Using the CellSearch technology, CTCs were assessed prospectively in peripheral blood of 53 R/M-HNC patients. We performed spiking experiments to test the diagnostic performance of the CellSearch platform in identifying squamous carcinoma cells.
  
  
  RESULTS
  CTCs were identified in 14 (26%) and 22 (41%) patients at baseline and at any time point, respectively. In univariate analysis ≥2 CTCs had a poorer prognostic role than 0-1 CTC. In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53-6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48-6.0, p 0.002]. A disease control after systemic therapy was obtained in 8% of CTC-positive patients as opposed to 45% in CTC-negative ones (p 0.03). The epidermal growth factor receptor (EGFR) expression was identified in 45% of CTC-positive patients.
  
  
  CONCLUSIONS
  In conclusion, CTCs are detected in one out of three patients with RM-HNC. CTC detection is a strong prognostic parameter and may be predictive of treatment efficacy. The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor.
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.affiliation: Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Almici
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Consoli
authors.affiliation: Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Verardi
authors.affiliation: Otorhinolaryngology, Head and Neck Surgery Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bolzoni-Villaret
authors.affiliation: Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bianchetti
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ciccarese
authors.affiliation: Department of Radiation Oncology, University of Florence, Florence, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Mangoni
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ferrari
authors.affiliation: Department of Radiation Oncology, University of Florence, Florence, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Biti
authors.affiliation: Department of Transfusion Medicine, Laboratory for Stem Cell Manipulation and Cryopreservation, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Marini
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Vittorio D
authors.initials: VD
authors.lastname: Ferrari
authors.affiliation: Otorhinolaryngology, Head and Neck Surgery Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
authors.affiliation: Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Magrini
authors.affiliation: Medical Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
mesh_terms: D014408:Biomarkers, Tumor; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000378:metabolism; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000473:pathology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D016017:Odds Ratio; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor; C512478:EGFR protein, human; D066246:ErbB Receptors
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