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J Chest Surg

Published online April 20, 2022

Copyright © Journal of Chest Surgery.

Prognostic Role of Circulating Tumor Cells in the Pulmonary Vein, Peripheral Blood, and Bone Marrow in Resectable Non-Small Cell Lung Cancer

Jeong Moon Lee, M.D.1 , Woohyun Jung, M.D.2 , Sungwon Yum, B.S.2 , Jeong Hoon Lee, Ph.D.3 , Sukki Cho, M.D., Ph.D.2,4

1Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Iksan; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam; 3Division of Biomedical Informatics, Seoul National University Biomedical Informatics, Seoul National University College of Medicine; 4Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Sukki Cho
Tel 82-31-787-7132
Fax 82-31-787-4050
E-mail skcho@snubh.org; tubincho@snu.ac.kr
ORCID
https://orcid.org/0000-0002-9309-8865

Received: November 17, 2021; Revised: January 24, 2022; Accepted: March 2, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Studies of the prognostic role of circulating tumor cells (CTCs) in early-stage non-small cell lung cancer (NSCLC) are still limited. This study investigated the prognostic power of CTCs from the pulmonary vein (PV), peripheral blood (PB), and bone marrow (BM) for postoperative recurrence in patients who underwent curative resection for NSCLC.
Methods: Forty patients who underwent curative resection for NSCLC were enrolled. Before resection, 10-mL samples were obtained of PB from the radial artery, blood from the PV of the lobe containing the tumor, and BM aspirates from the rib. A microfabricated filter was used for CTC enrichment, and immunofluorescence staining was used to identify CTCs.
Results: The pathologic stage was stage I in 8 patients (20%), II in 15 (38%), III in 14 (35%), and IV in 3 (8%). The median number of PB-, PV-, and BM-CTCs was 4, 4, and 5, respectively. A time-dependent receiver operating characteristic curve analysis showed that PB-CTCs had excellent predictive value for recurrence-free survival (RFS), with the highest area under the curve at each time point (first, second, and third quartiles of RFS). In a multivariate Cox proportional hazard regression model, PB-CTCs were an independent risk factor for recurrence (hazard ratio, 10.580; 95% confidence interval, 1.637?68.388; p<0.013).
Conclusion: The presence of ≥4 PB-CTCs was an independent poor prognostic factor for RFS, and PV-CTCs and PB-CTCs had a positive linear correlation in patients with recurrence.

Keywords: Circulating tumor cells, Non-small-cell lung carcinoma, Pulmonary veins, Bone marrow, Peripheral blood

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J Chest Surg

Published online April 20, 2022

Copyright © Journal of Chest Surgery.

Prognostic Role of Circulating Tumor Cells in the Pulmonary Vein, Peripheral Blood, and Bone Marrow in Resectable Non-Small Cell Lung Cancer

Jeong Moon Lee, M.D.1 , Woohyun Jung, M.D.2 , Sungwon Yum, B.S.2 , Jeong Hoon Lee, Ph.D.3 , Sukki Cho, M.D., Ph.D.2,4

1Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Iksan; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam; 3Division of Biomedical Informatics, Seoul National University Biomedical Informatics, Seoul National University College of Medicine; 4Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Sukki Cho
Tel 82-31-787-7132
Fax 82-31-787-4050
E-mail skcho@snubh.org; tubincho@snu.ac.kr
ORCID
https://orcid.org/0000-0002-9309-8865

Received: November 17, 2021; Revised: January 24, 2022; Accepted: March 2, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Studies of the prognostic role of circulating tumor cells (CTCs) in early-stage non-small cell lung cancer (NSCLC) are still limited. This study investigated the prognostic power of CTCs from the pulmonary vein (PV), peripheral blood (PB), and bone marrow (BM) for postoperative recurrence in patients who underwent curative resection for NSCLC.
Methods: Forty patients who underwent curative resection for NSCLC were enrolled. Before resection, 10-mL samples were obtained of PB from the radial artery, blood from the PV of the lobe containing the tumor, and BM aspirates from the rib. A microfabricated filter was used for CTC enrichment, and immunofluorescence staining was used to identify CTCs.
Results: The pathologic stage was stage I in 8 patients (20%), II in 15 (38%), III in 14 (35%), and IV in 3 (8%). The median number of PB-, PV-, and BM-CTCs was 4, 4, and 5, respectively. A time-dependent receiver operating characteristic curve analysis showed that PB-CTCs had excellent predictive value for recurrence-free survival (RFS), with the highest area under the curve at each time point (first, second, and third quartiles of RFS). In a multivariate Cox proportional hazard regression model, PB-CTCs were an independent risk factor for recurrence (hazard ratio, 10.580; 95% confidence interval, 1.637?68.388; p<0.013).
Conclusion: The presence of ≥4 PB-CTCs was an independent poor prognostic factor for RFS, and PV-CTCs and PB-CTCs had a positive linear correlation in patients with recurrence.

Keywords: Circulating tumor cells, Non-small-cell lung carcinoma, Pulmonary veins, Bone marrow, Peripheral blood

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