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    EPAC-lung: European pooled analysis of the prognostic value of circulating tumour cells in small cell lung cancer

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    Authors
    Foy, Victoria
    Lindsay, Colin R
    Carmel, A.
    Fernandez-Gutierrez, Fabiola
    Krebs, Matthew G
    Priest, Lynsey
    Carter, Mathew
    Groen, H. J. M.
    Hiltermann, T. J. N.
    de Luca, A.
    Farace, F.
    Besse, B.
    Terstappen, L.
    Rossi, E.
    Morabito, A.
    Perrone, F.
    Renehan, Andrew G
    Faivre-Finn, Corinne
    Normanno, N.
    Dive, Caroline
    Blackhall, Fiona H
    Michiels, S.
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    Affiliation
    Cancer Research UK Manchester Institute Cancer Biomarker Centre, Cancer Research UK Manchester Institute, University of Manchester, Manchester, U
    Issue Date
    2021
    
    Metadata
    Show full item record
    Abstract
    Background: Circulating tumour cell (CTC) number is an independent prognostic factor in patients with small cell lung cancer (SCLC) but there is no consensus on the CTC threshold for prognostic significance. We undertook a pooled analysis of individual patient data to clinically validate CTC enumeration and threshold for prognostication. Methods: Four European cancer centres, experienced in CellSearch CTC enumeration for SCLC provided pseudo anonymised data for patients who had undergone pre-treatment CTC count. Data was collated, and Cox regression models, stratified by centre, explored the relationship between CTC count and survival. The added value of incorporating CTCs into clinico-pathological models was investigated using likelihood ratio tests. Results: A total of 367 patient records were evaluated. A one-unit increase in log-transformed CTC counts corresponded to an estimated hazard ratio (HR) of 1.24 (95% CI: 1.19-1.29, P<0.0001) for progression free survival (PFS) and 1.23 (95% CI: 1.18-1.28, P<0.0001) for overall survival (OS). CTC count of ≥15 or ≥50 was significantly associated with an increased risk of progression (CTC ≥15: HR 3.20, 95% CI: 2.50-4.09, P<0.001; CTC ≥50: HR 2.56, 95% CI: 2.01-3.25, P<0.001) and an increased risk of death (CTC ≥15: HR 2.90, 95% CI: 2.28-3.70, P<0.001; CTC ≥50: HR 2.47, 95% CI: 1.95-3.13, P<0.001). There was no significant inter-centre heterogeneity observed. Addition of CTC count to clinico-pathological models as a continuous log-transformed variable, offers further prognostic value (both likelihood ratio P<0.001 for OS and PFS). Conclusions: Higher pre-treatment CTC counts are a negative independent prognostic factor in SCLC when considered as a continuous variable or dichotomised counts of ≥15 or ≥50. Incorporating CTC counts, as a continuous variable, improves clinic-pathological prognostic models.
    Citation
    Foy V, Lindsay CR, Carmel A, Fernandez-Gutierrez F, Krebs MG, Priest L, et al. EPAC-lung: European pooled analysis of the prognostic value of circulating tumour cells in small cell lung cancer. Transl Lung Cancer Res. 2021 Apr;10(4):1653–65.
    Journal
    Translational Lung Cancer Research
    URI
    http://hdl.handle.net/10541/624064
    DOI
    10.21037/tlcr-20-1061
    PubMed ID
    34012782
    Additional Links
    https://dx.doi.org/10.21037/tlcr-20-1061
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.21037/tlcr-20-1061
    Scopus Count
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