Circulating tumor cells as trigger to hematogenous spreads and potential biomarkers to predict the prognosis in ovarian cancer.
Despite several improvements in the surgical field and in the systemic treatment, ovarian cancer (OC) is still characterized by high recurrence rates and consequently poor survival. In OC, there is still a great lack of knowledge with regard to cancer behavior and mechanisms of recurrence, progression, and drug resistance. The OC metastatization process mostly occurs via intracoelomatic spread. Recent evidences show that tumor cells generate a favorable microenvironment consisting in T regulatory cells, T infiltrating lymphocytes, and cytokines which are able to establish an "immuno-tolerance mileau" in which a tumor cell can become a resistant clone. When the disease responds to treatment, immunoediting processes and cancer progression have been stopped. A similar inhibition of the immunosuppressive microenvironment has been observed after optimal cytoreductive surgery as well. In this scenario, the early identification of circulating tumor cells could represent a precocious signal of loss of the immune balance that precedes cancer immunoediting and relapse. Supporting this hypothesis, circulating tumor cells have been demonstrated to be a prognostic factor in several solid tumors such as colorectal, pancreatic, gastric, breast, and genitourinary cancer. In OC, the role of circulating tumor cells is still to be defined. However, as opposed to healthy women, circulating tumor cells have been demonstrated in peripheral blood of OC patients, opening a new research field in OC diagnosis, treatment monitoring, and follow-up.
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy. marialuisa.gasparri@uniroma1.it.
Maria Luisa
ML
Gasparri
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Delia
D
Savone
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Raad Aris
RA
Besharat
Laboratory for Translational Oncology and Personalized Medicine, Rashid Latif Medical College, Lahore, Pakistan.
Ammad Ahmad
AA
Farooqi
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Filippo
F
Bellati
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Ilary
I
Ruscito
Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Pierluigi Benedetti
PB
Panici
Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland.
Andrea
A
Papadia
D000818:Animals; D014408:Biomarkers, Tumor / Q000097:blood* / Q000276:immunology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007107:Immune System; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009360:Neoplastic Cells, Circulating / Q000276:immunology*; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D011379:Prognosis; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D016896:Treatment Outcome
D014408:Biomarkers, Tumor
Circulating tumor cells; Immunoediting; Ovarian cancer; Prognostic markers; Tumor immunology