title: Value of circulating tumor cells positive for thyroid transcription factor-1 (TTF-1) to predict recurrence and survival rates for endometrial carcinoma.
abstract: OBJECTIVE
  This study was conducted to analyze the predictive value of circulating tumor cells (CTC) expressing thyroid transcription factor-1 (TTF-1) on the recurrence and survival rates of endometrial carcinoma patients treated with laparoscopic surgery.
  
  
  METHODS
  78 patients were recruited, diagnosed with endometrial carcinoma and measured CTC expressing TTF-1 using flow cytometry in blood and tissues. Then, the patients were distributed into TTF-1-positive (N=42) and -negative (N=36) groups. The levels of HE4 were determined by ELISA, the levels of cancer antigen CA125 and CA15.3 by chemiluminescent immunoassay, and the levels of mRNA expression of survivin, β-catenin, miR-15a, and PTEN by RT-PCR assay from endometrial carcinoma samples.
  
  
  RESULTS
  Patients in TTF-1-positive group had mainly TNM stages II and III-IV, whereas the TTF-1-negative group stages I and II predominated. The rates of vascular infiltration and lymphatic metastasis in the TTF-1-positive group were higher compared with the TTF-1-negative group (p<0.05). The serum levels of CA125, CA15.3, and HE4 were significantly higher in the TTF-1-positive group than in the TTF-1-negative group (p<0.05). The levels of survivin and β-catenin mRNA expression in endometrial carcinoma in the TTF-1-positive group was higher than in the TTF-1-negative group. In contrast, the levels of miR-15a and PTEN mRNA expression were lower in the TTF-1-positive group (p<0.05). The median follow-up duration was 25 months for both groups. At that time, progression-free survival (PFS) and the median survival time decreased in the TTF-1-positive group compared with the TTF-1-negative group. Additionally, the recurrence rate increased in the TTF-1-positive group.
  
  
  CONCLUSIONS
  The rate of TTF-1-positive CTC was strongly correlated with TNM staging, vascular infiltration, lymphatic metastasis, and the levels of CA125, CA15.3, and HE4 in endometrial carcinoma. The levels of survivin, β-catenin, miR-15a, and PTEN mRNA also contributed to predict survival rates after laparoscopic surgery.
authors.affiliation: Department of Obstetrics & Gynecology, Tianjing Medical University, Tianjin, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Qu
authors.forename: Peng Peng
authors.initials: PP
authors.lastname: Qu
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood* / Q000235:genetics; D018394:CA-125 Antigen / Q000097:blood; D018269:Carcinoma, Endometrioid / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008565:Membrane Proteins / Q000097:blood; D035683:MicroRNAs / Q000235:genetics; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000737:chemistry* / Q000473:pathology; D009687:Nuclear Proteins / Q000097:blood*; D051059:PTEN Phosphohydrolase / Q000235:genetics; D011237:Predictive Value of Tests; D011506:Proteins / Q000378:metabolism; D015996:Survival Rate; D000074482:Thyroid Nuclear Factor 1; D013997:Time Factors; D014157:Transcription Factors / Q000097:blood*; D016896:Treatment Outcome; D000081102:WAP Four-Disulfide Core Domain Protein 2; D051176:beta Catenin / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C495270:CTNNB1 protein, human; C505361:MIRN15 microRNA, human; C451759:MUC16 protein, human; D008565:Membrane Proteins; D035683:MicroRNAs; C000614412:NKX2-1 protein, human; D009687:Nuclear Proteins; D011506:Proteins; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human; D051176:beta Catenin; D051059:PTEN Phosphohydrolase; C494929:PTEN protein, human