Background: This study investigated the association of circulating tumor cells (CTCs) change during chemoradiation with the treatment response and survival profiles in advanced nonsmall-cell lung cancer (NSCLC) patients. Materials and Methods: Fifty-eight advanced NSCLC patients who underwent concurrent chemoradiation were enrolled; their peripheral blood samples were collected before chemoradiation, and at 1 month postchemoradiation, the CTCs were assayed using a CTC-Biopsy system. Moreover, CTCs were classified as CTCs positive and CTCs negative according to CTCs' count, and change of CTCs was calculated. In addition, response of chemoradiation was evaluated at 1 month postchemoradiation, then progression-free survival (PFS) and overall survival (OS) were assessed. Results: Prechemoradiation CTCs positive were associated with increased TNM stage, but not other clinicopathologic characteristics. After chemoradiation, the CTCs' number [1.0 (0.0-3.0) vs. 4.0 (2.0-10.0)] and the percentage of CTC-positive cases (37.9% vs. 77.6%) were both decreased compared to those before chemoradiation. Regarding treatment response, prechemoradiation CTCs positive were associated with lower partial response; postchemoradiation CTCs positive were associated with reduced disease control rate, while CTCs' change during chemoradiation was not associated with treatment response. Kaplan-Meier curves showed that postchemoradiation CTCs positive and increased CTCs' number during chemoradiation were associated with reduced PFS, then multivariate Cox's regression analysis disclosed that they independently predicted decreased PFS. However, no correlation of CTCs' status or CTCs' change with OS was observed. Conclusions: Prechemoradiation CTCs relate to increased TNM stage and worse prognosis in chemoradiation-treated advanced NSCLC patients.
Keywords: advanced nonsmall-cell lung cancer; chemoradiation; circulating tumor cells; overall survival; progression-free survival; treatment response.