PO.CL01.22 · 临床研究
利用循环上皮肿瘤细胞（CETC/CTC）数量的轨迹早期检测前列腺癌
Early detection of prostate carcinoma using trajectories of circulating epithelial tumor cell (CETCs/CTCs) numbers
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：前列腺癌是老年男性死亡的主要原因，凸显了对早期有效检测策略的需求。基于PSA的筛查由于在降低死亡率方面的获益不确定以及相关风险（如侵入性、共病和过度诊断）而仍存争议。过度诊断可能导致对惰性疾病的不必要治疗和并发症。在临床实践中，患者在咨询后往往只保留有限的信息，而医生风险沟通的不一致可能阻碍知情的共同决策。因此，在前列腺癌风险增加的患者中使用连续循环上皮肿瘤细胞（CETC/CTC）的微创筛查方法可能有助于知情决策。
方法：在一个筛查队列（n=35）中对50-85岁男性以及在接受PSMA-PET检查以排查疑似前列腺癌的患者（n=49）的外周血中对CETC/CTC进行定量。在PSMA-PET检查时测量PSA水平，并将连续CETC/CTC计数与PSMA-PET结果相关联。
结果：PSMA-PET扫描阳性（n=27）与阴性（n=24）患者之间的血清PSA水平无显著差异（p=0.94）。然而，与筛查队列相比，PSMA-PET阳性患者的CETC/CTC计数显著更高（p<0.001）。ROC分析确定了每mL血液450个CETC/CTC的最佳阈值，特异性为0.7，敏感性为0.6。连续监测揭示了不同的轨迹：在后来出现PSMA-PET阳性结果的患者中，13例中有11例（90%）观察到CETC/CTC计数上升，而在CETC/CTC计数下降的21例患者中仅有2例（8%）为PSMA-PET阳性。Kaplan-Meier分析显示两组之间的PSMA-PET无事件生存期存在高度显著差异（p<0.001；风险比9.48）。
结论：CETC/CTC的连续监测为前列腺癌活动提供了动态、非侵入性的见解。CETC/CTC计数上升与PSMA-PET阳性密切相关，提示其作为前列腺癌进展和治疗监测早期生物标志物的潜力。
查看英文原文 English abstract
Background: Prostate cancer is a leading cause of mortality in elderly men, underscoring the need for early and effective detection strategies. PSA-based screening remains controversial due to uncertain benefits in reducing mortality and associated risks, such as invasiveness, comorbidities, and overdiagnosis. Overdiagnosis can lead to unnecessary treatments and complications for indolent disease. In clinical practice, patients often retain limited information after consultations, and inconsistent risk communication by physicians can hinder informed shared decision-making. Therefore, a minimally invasive screening approach using serial circulating epithelial tumor cells (CETCs/CTCs) in patients at increased risk of prostate cancer may enhance informed decision-making.
Methods: CETCs/CTCs were quantified in peripheral blood from men aged 50-85 years in a screening cohort (n=35) and in patients undergoing PSMA-PET for suspected prostate cancer (n=49). PSA levels were measured at the time of PSMA-PET, and serial CETC/CTC counts were correlated with PSMA-PET findings.
Results: Serum PSA levels did not differ significantly between patients with positive (n=27) and negative (n=24) PSMA-PET scans (p=0.94). However, CETC/CTC counts were significantly higher in PSMA-PET-positive patients compared to those in the screening cohort (p<0.001). ROC analysis identified an optimal threshold of 450 CETCs/CTCs per mL blood, with a specificity of 0.7 and a sensitivity of 0.6. Serial monitoring revealed distinct trajectories: increasing CETC/CTC counts were observed in 11 of 13 (90%) patients who later developed PSMA-PET-positive findings, while only 2 of 21 (8%) patients with decreasing CETC/CTC counts were PSMA-PET positive. Kaplan-Meier analysis demonstrated a highly significant difference in PSMA-PET-free survival between the two groups (p<0.001; hazard ratio 9.48).
Conclusions: Serial monitoring of CETCs/CTCs provides dynamic, non-invasive insights into prostate cancer activity. Rising CETC/CTC counts were strongly associated with PSMA-PET positivity, suggesting their potential as early biomarkers for prostate cancer progression and treatment monitoring.
利益披露 Disclosure
D. Schott, None..
J. Fluhrer, None..
U. Pachmann, None..
P. Eng, None.