title: Circulating Tumor Cells Identify Early Recurrence in Patients with Non-Small Cell Lung Cancer Undergoing Radical Resection.
abstract: BACKGROUND
  Surgery is the treatment of choice for patients with non-small cell lung cancer (NSCLC) stages I-IIIA. However, more than 20% of these patients develop recurrence and die due to their disease. The release of tumor cells into peripheral blood (CTCs) is one of the main causes of recurrence of cancer. The objectives of this study are to identify the prognostic value of the presence and characterization of CTCs in peripheral blood in patients undergoing radical resection for NSCLC.
  
  
  METHODS
  56 patients who underwent radical surgery for previously untreated NSCLC were enrolled in this prospective study. Peripheral blood samples for CTC analysis were obtained before and one month after surgery. In addition CTCs were phenotypically characterized by epidermal growth factor receptor (EGFR) expression.
  
  
  RESULTS
  51.8% of the patients evaluated were positive with the presence of CTCs at baseline. A decrease in the detection rate of CTCs was observed in these patients one month after surgery (32.1%) (p = 0.035). The mean number of CTCs was 3.16 per 10 ml (range 0-84) preoperatively and 0.66 (range 0-3) in postoperative determination. EGFR expression was found in 89.7% of the patients at baseline and in 38.9% patients one month after surgery. The presence of CTCs after surgery was significantly associated with early recurrence (p = 0.018) and a shorter disease free survival (DFS) (p = .008). In multivariate analysis CTC presence after surgery (HR = 5.750, 95% CI: 1.50-21.946, p = 0.010) and N status (HR = 0.296, 95% CI: 0.091-0.961, p = 0.043) were independent prognostic factors for DFS.
  
  
  CONCLUSIONS
  CTCs can be detected and characterized in patients undergoing radical resection for non-small cell lung cancer. Their presence might be used to identify patients with increased risk of early recurrence.
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bayarri-Lara
authors.affiliation: GENYO, Centre for Genomics and Oncological Research (Pfizer / University of Granada / Andalusian Regional Government), PTS Granada Av. de la Ilustración, 114-18016, Granada, Spain.
authors.forename: Francisco G
authors.initials: FG
authors.lastname: Ortega
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cueto Ladrón de Guevara
authors.affiliation: GENYO, Centre for Genomics and Oncological Research (Pfizer / University of Granada / Andalusian Regional Government), PTS Granada Av. de la Ilustración, 114-18016, Granada, Spain.|Integral Oncology Division, San Cecilio Clinical University Hospital, Av. Dr. Olóriz 16, 18012, Granada, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Puche
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz Zafra
authors.affiliation: GENYO, Centre for Genomics and Oncological Research (Pfizer / University of Granada / Andalusian Regional Government), PTS Granada Av. de la Ilustración, 114-18016, Granada, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: de Miguel-Pérez
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Abel Sánchez-Palencia
authors.initials: AS
authors.lastname: Ramos
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Carlos Fernando
authors.initials: CF
authors.lastname: Giraldo-Ospina
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas, 2, 18014, Granada, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Navajas Gómez
authors.affiliation: Division of Preventive Medicine and Public Health, CIBERESP, University of Jaén, Campus de las Lagunillas, Ctra Torrequebradilla s/n, 23071, Jaén, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Delgado-Rodriguez
authors.affiliation: GENYO, Centre for Genomics and Oncological Research (Pfizer / University of Granada / Andalusian Regional Government), PTS Granada Av. de la Ilustración, 114-18016, Granada, Spain.|Laboratory of Genetic Identification, Department of Legal Medicine, University of Granada, Avda. Madrid 11, 18012, Granada, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Lorente
authors.affiliation: GENYO, Centre for Genomics and Oncological Research (Pfizer / University of Granada / Andalusian Regional Government), PTS Granada Av. de la Ilustración, 114-18016, Granada, Spain.|Integral Oncology Division, San Cecilio Clinical University Hospital, Av. Dr. Olóriz 16, 18012, Granada, Spain.
authors.forename: María Jose
authors.initials: MJ
authors.lastname: Serrano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D066246:ErbB Receptors / Q000097:blood; D005260:Female; D006801:Humans; D007633:Keratins / Q000097:blood; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D009360:Neoplastic Cells, Circulating / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D014408:Biomarkers, Tumor; D007633:Keratins; C512478:EGFR protein, human; D066246:ErbB Receptors