Thorac Cardiovasc Surg 2016; 64(06): 515-519
DOI: 10.1055/s-0035-1552925
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

The Effects of Different Surgical Approaches on the Perioperative Level of Circulating Tumor Cells in Patients with Non-Small Cell Lung Cancer

Hong Bo Huang
1   Department of Thoracic Surgery, Ningbo No. 2 Hospital, Ningbo, Zhejiang Province, China
,
Ming Jian Ge
2   Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
› Author Affiliations
Further Information

Publication History

03 January 2015

29 March 2015

Publication Date:
01 June 2015 (online)

Abstract

Background To observe and compare the effects of video-assisted thoracoscopic surgery (VATS) and conventional thoracotomy on the levels of circulating tumor cells (CTCs) in patients with non-small cell lung carcinoma (NSCLC).

Methods Seventy-nine patients with a diagnosis of NSCLC were enrolled in the study. Forty-three were treated with VATS and 36 were treated with conventional thoracotomy. Blood samples were collected 3 days prior to surgery (d-3), during surgery (d0), and 3 days after surgery (d3). After epithelial cell adhesion molecule (EpCAM)-labeled immunomagnetic cell enrichment, anti-CK-PE and anti-CD45-FITC fluorescent-labeled monoclonal antibodies were added to sort CTCs. Quantification of CTCs was performed using multiparameter flow cytometry.

Results The number of CTCs on d0 was significantly higher than on d-3 (5.730 ± 4.266 vs. 4.142  ± 3.971, p = 0.033) in both groups. There was no significant difference in the change of CTCs from before surgery to during surgery in the VATS and conventional thoracotomy (open) groups (1.363  ± 2.924 vs. 1.500  ± 2.315, p = 0.329). However, the increase in number of CTCs from before surgery to after surgery was significantly lower in the VATS group than in the conventional thoracotomy (open) group (2.181  ± 2.962 vs. 9.666  ± 15.641, p = 0.015). Thirty of the 79 patients tested positive for CTCs before surgery (37.97%). All benign lung disease patients and volunteers tested negative for CTCs.

Conclusion A smaller increase in CTCs was seen in patients treated with VATS lobectomy than in patients treated with conventional thoracotomy. This reduction in number of postoperative CTCs may improve long-term survival.

 
  • References

  • 1 Mavroudis D. Circulating cancer cells. Ann Oncol 2010; 21 (Suppl. 07) vii95-vii100
  • 2 Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg 2001; 20 (3) 455-463
  • 3 Paterlini-Brechot P, Benali NL. Circulating tumor cells (CTC) detection: clinical impact and future directions. Cancer Lett 2007; 253 (2) 180-204
  • 4 Deng G, Herrler M, Burgess D, Manna E, Krag D, Burke JF. Enrichment with anti-cytokeratin alone or combined with anti-EpCAM antibodies significantly increases the sensitivity for circulating tumor cell detection in metastatic breast cancer patients. Breast Cancer Res 2008; 10 (4) R69
  • 5 Spizzo G, Fong D, Wurm M , et al. EpCAM expression in primary tumour tissues and metastases: an immunohistochemical analysis. J Clin Pathol 2011; 64 (5) 415-420
  • 6 Khan MS, Tsigani T, Rashid M , et al. Circulating tumor cells and EpCAM expression in neuroendocrine tumors. Clin Cancer Res 2011; 17 (2) 337-345
  • 7 Chen Q, Ge F, Cui W , et al. Lung cancer circulating lung cancer tumor cells isolated by the EpCAM-independent enrichment strategy correlate with Cytokeratin 19-derived CYFRA21–1 and pathological staging. Clin Chim Acta 2013; 419: 57-61
  • 8 Lustberg M, Jatana KR, Zborowski M, Chalmers JJ. Emerging technologies for CTC detection based on depletion of normal cells. Recent Results Cancer Res 2012; 195: 97-110
  • 9 Takao M, Takeda K. Enumeration, characterization, and collection of intact circulating tumor cells by cross contamination-free flow cytometry. Cytometry A 2011; 79 (2) 107-117
  • 10 Ge MJ, Shi D, Wu QC, Wang M, Li LB. Observation of circulating tumour cells in patients with non-small cell lung cancer by real-time fluorescent quantitative reverse transcriptase-polymerase chain reaction in peroperative period. J Cancer Res Clin Oncol 2006; 132 (4) 248-256
  • 11 Ng CS, Whelan RL, Lacy AM, Yim AP. Is minimal access surgery for cancer associated with immunologic benefits?. World J Surg 2005; 29 (8) 975-981
  • 12 Hase S, Weinitschke K, Fischer K , et al. Monitoring peri-operative immune suppression in renal cancer patients. Oncol Rep 2011; 25 (5) 1455-1464
  • 13 Whitson BA, D'Cunha J, Maddaus MA. Minimally invasive cancer surgery improves patient survival rates through less perioperative immunosuppression. Med Hypotheses 2007; 68 (6) 1328-1332
  • 14 Ng CS, Lee TW, Wan S , et al. Thoracotomy is associated with significantly more profound suppression in lymphocytes and natural killer cells than video-assisted thoracic surgery following major lung resections for cancer. J Invest Surg 2005; 18 (2) 81-88
  • 15 Ng CS, Wan S, Hui CW, Lee TW, Underwood MJ, Yim AP. Video-assisted thoracic surgery for early stage lung cancer - can short-term immunological advantages improve long-term survival?. Ann Thorac Cardiovasc Surg 2006; 12 (5) 308-312
  • 16 Chang KT, Tsai CM, Chiou YC, Chiu CH, Jeng KS, Huang CY. IL-6 induces neuroendocrine dedifferentiation and cell proliferation in non-small cell lung cancer cells. Am J Physiol Lung Cell Mol Physiol 2005; 289 (3) L446-L453
  • 17 Whitson BA, D'Cunha J, Andrade RS , et al. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg 2008; 86 (6) 1735-1744
  • 18 Ito Y, Oda M, Tsunezuka Y , et al. Reduced perioperative immune response in video-assisted versus open surgery in a rat model. Surg Today 2009; 39 (8) 682-688
  • 19 Katoh M, Neumaier M, Nezam R, Izbicki JR, Schumacher U. Correlation of circulating tumor cells with tumor size and metastatic load in a spontaneous lung metastasis model. Anticancer Res 2004; 24 (3a) 1421-1425
  • 20 Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27 (15) 2553-2562
  • 21 Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008; 86 (6) 2008-2016 , discussion 2016–2018