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Shirong Zhang,1,* Tiecheng Wu,2,* Xinguo Peng,3 Jian Liu,4 Fang Liu,5 Shiyang Wu,5 Suyan Liu,5 Yan Dong,5 Shujun Xie,1 Shenglin Ma6 1Translational Medicine Research Center, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China; 2Department of Oncology, PKUCare Luzhong Hospital, Zibo, China; 3Department of Laboratory, Binzhou Medical University Hospital, Binzhou, China; 4Department of Breast Surgery, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China; 5SurExam Bio-Tech Co., Guangzhou, China; 6Department of Oncology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China *These authors contributed equally to this work Abstract: In this study, we investigated the relationship between the epithelial–mesenchymal transition phenotype of circulating tumor cells (CTCs) and distant metastasis in breast cancer patients. We analyzed the expression of epithelial (epithelial cell adhesion molecule, cytokeratin [CK]8, CK18 and CK19) and mesenchymal (vimentin and TWIST1) markers in CTCs from a large cohort of Chinese breast cancer patients (N=1083) using Canpatrol™ CTC assays. We identified CTCs in 84.9% (920/1083) of the breast cancer patients enrolled in this study. Among these 920 patients, 547 showed epithelial CTCs, 793 showed biphenotypic CTCs and 516 showed mesenchymal CTCs. Receiver operating characteristic (ROC) curves demonstrated circulation of both biphenotypic and mesenchymal CTCs (area under ROC curve value: 0.728; sensitivity: 68.7% and specificity: 71.6%) in patients was associated with distant metastasis. These findings demonstrate that the epithelial–mesenchymal transition phenotype of CTCs is a potential biomarker predictive of distant metastasis in breast cancer. Keywords: breast cancer, circulating tumor cells, epithelial–mesenchymal transition, distant metastasis, prediction |
