title: Circulating Tumour Cells as an Independent Prognostic Factor in Patients with Advanced Oesophageal Squamous Cell Carcinoma Undergoing Chemoradiotherapy.
abstract: The role of circulating tumour cells (CTCs) in advanced oesophageal cancer (EC) patients undergoing concurrent chemoradiotherapy (CCRT) remains uncertain. A negative selection protocol plus flow cytometry was validated to efficiently identify CTCs. The CTC number was calculated and analysed for survival impact. The protocol's efficacy in CTC identification was validated with a recovery rate of 44.6 ± 9.1% and a coefficient of variation of 20.4%. Fifty-seven patients and 20 healthy donors were enrolled. Initial staging, first response to CRT, and surgery after CRT were prognostic for overall survival, with P values of <0.0001, <0.0001, and <0.0001, respectively. The CTC number of EC patients is significantly higher (P = 0.04) than that of healthy donors. Multivariate analysis for disease-specific progression-free survival showed that surgery after response to CCRT, initial stage, and CTC number (≥21.0 cells/mL) played independent prognostic roles. For overall survival, surgery after CCRT, performance status, initial stage, and CTC number were significant independent prognostic factors. In conclusion, a negative selection plus flow cytometry protocol efficiently detected CTCs. The CTC number before CCRT was an independent prognostic factor in patients with unresectable oesophageal squamous cell carcinoma. Further large-scale prospective studies for validation are warranted.
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Su
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Biochemical and Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.|Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan.
authors.forename: Min-Hsien
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.|Cancer Center Karolinska, Karolinska University Hospital, Stockholm SE-17176, Sweden.
authors.forename: Wen-Kuan
authors.initials: WK
authors.lastname: Huang
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Northern Institute for Cancer Research, School of Medicine, Newcastle University, Newcastle, United Kingdom.
authors.forename: Chiao-En
authors.initials: CE
authors.lastname: Wu
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsien-Kun
authors.initials: HK
authors.lastname: Chang
authors.affiliation: Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.affiliation: Graduate Institute of Biochemical and Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tzu-Keng
authors.initials: TK
authors.lastname: Chiu
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Nina Ming-Jung
authors.initials: NM
authors.lastname: Lin
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Siou-Ru
authors.initials: SR
authors.lastname: Ye
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jane Ying-Chieh
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Circulating Tumour Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Chemical and Materials Engineering, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000378:metabolism* / Q000473:pathology; D015996:Survival Rate