The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer

Author(s):Show less -

Abdallah, Emne A. ^[1] ; Braun, Alexcia C. ^[1] ; Flores, Bianca C. T. C. P. ^[1] ; Senda, Lais ^[1] ; Urvanegia, Ana Claudia ^[1] ; Calsavara, Vinicius ^[1] ; Fonseca de Jesus, Victor Hugo ^[2] ; Arruda Almeida, Maria Fernanda ^[3] ; Begnami, Maria Dirlei ^[4] ; Coimbra, Felipe J. F. ^[5] ; da Costa Jr, Wilson Luiz ; Nunes, Diana Noronha ^[1] ; DiasNeto, Emmanuel ^[1] ; Domingos Chinen, Ludmilla T. ^[1]

Affiliation

^[1] AC Camargo Canc Ctr, Int Res Ctr, Sao Paulo - Brazil

^[2] AC Camargo Canc Ctr, Dept Med Oncol, Sao Paulo - Brazil

^[3] AC Camargo Canc Ctr, Dept Imaging, Sao Paulo - Brazil

^[4] AC Camargo Canc Ctr, Dept Anat Pathol, Sao Paulo - Brazil

^[5] AC Camargo Canc Ctr, Dept Abdominal Surg Surg Oncol, Sao Paulo - Brazil

• Document type: Journal article
• Source: ONCOLOGIST; v. 24, n. 9, p. E854-E863, SEP 2019.
• Web of Science Citations: 2

Abstract

Background Gastric adenocarcinoma (GAC) is the third deadliest malignant neoplasm worldwide, mostly because of late disease diagnosis, low chemotherapy response rates, and an overall lack of tumor biology understanding. Therefore, tools for prognosis and prediction of treatment response are needed. Quantification of circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) and their expression of biomarkers has potential clinical relevance. Our aim was to evaluate CTCs and CTM and their expression of HER2 and plakoglobin in patients with nonmetastatic GAC, correlating the findings to clinicopathological data. Materials and Methods CTC enrichment was performed with isolation by size of epithelial tumor cells, and the analysis was performed with immunocytochemistry and microscopy. Two collections were made: one at diagnosis (55 samples before neoadjuvant treatment) and one after surgery and before adjuvant therapy (33 samples). Results A high detection rate of CTCs (90%) was observed at baseline. We evaluated HER2 expression in 45/55 biopsy samples and in 42/55 CTC samples, with an overlap of 36 subjects. Besides the good agreement observed for HER2 expression in primary tumors and paired CTCs for 36 cases (69.4%; kappa = 0.272), the analysis of HER2 in CTCs showed higher positivity (43%) compared with primary tumors (11%); 3/5 patients with disease progression had HER2-negative primary tumors but HER2-positive CTCs. A significant CTC count drop in follow-up was seen for CTC-HER2-positive cases (4.45 to 1.0 CTCs per mL) compared with CTC-HER2-negative cases (2.6 to 1.0 CTCs per mL). The same was observed for CTC-plakoglobin-positive cases (2.9 to 1.25 CTCs per mL). Conclusion CTC analysis, including their levels, plakoglobin, and HER2 expression, appears to be a promising tool in the understanding the biology and prognosis of GAC. Implications for Practice The analysis of circulating tumor cell levels from the blood of patients with gastric adenocarcinoma, before and after neoadjuvant treatment, is useful to better understand the behavior of the disease as well as the patients more likely to respond to treatment. (AU)

• FAPESP's process: 14/26897-0 - Epidemiology and genomics of gastric adenocarcinomas in Brazil
• Grantee: Emmanuel Dias-Neto
• Support type: Research Projects - Thematic Grants
• FAPESP's process: 15/16952-6 - Identificação de Proteínas Relacionadas à Resistência a Quimioterapia em Células Tumorais Circulantes de Pacientes com Câncer de Cólon Localmente Avançado
• Grantee: Emne Ali Abdallah
• Support type: Scholarships in Brazil - Doctorate