Circulating Tumor Cells Predict Worse Outcomes in Bladder Cancer Patients

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SAN FRANCISCO—The presence of circulating tumor cells (CTC) in the peripheral blood of patients with urothelial carcinoma of the bladder (UCB) prior to radical cystecomy are associated with worse disease outcomes, researchers reported here at the annual Genitourinary Cancers Symposium.

The finding of even one CTC per 7.5 mL of blood independently predicts disease recurrence and cancer-related death, according to researchers who conducted a prospective study involving analyses of blood samples collected from 120 UCB patients prior to radical cystectomy.

The investigators, led by Michael Rink, MD, of Weill Cornell Medical College, said their findings are important for future investigations because they contradict theories that five or more CTC are needed for accurate outcome prediction. “Therefore, CTC may represent a feasible biomarker for monitoring response to neoadjuvant and adjuvant chemotherapy,” the researchers concluded.

Dr. Rink's group noted that CTC were detectable in 30 of 120 patients (25%), with an average number of 5.7 CTC. Eighteen patients (60%) had 1 CTC/7.5 mL, eight (26.7%) had 2-5 CTC, and four (13.3%) had more than 5 CTC.

At a median follow-up of 18 months after surgery, CTC detection prior to radical cystectomy was independently associated with a nearly fivefold increased risk of disease recurrence and cancer-related death, the study found. Disease recurrence and cancer-related death were not associated with the number of detected CTC.

In addition, CTC status was not associated with tumor stage, grade, lymph node metastases, or lymphovascular invasion, and increasing numbers of CTC were not associated with higher stages or increasing numbers of lymph node metastases, the researchers noted.

The symposium is co-sponsored by the American Society of Clinical Oncology, the American Society of Radiation Oncology, and the Society of Urologic Oncology.

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