Circulating tumor cells in patients with recurrent or metastatic head and neck carcinoma: Prognostic and predictive significance

Salvatore Grisanti, Camillo Almici, Francesca Consoli, Michela Buglione, Rosanna Verardi, Andrea Bolzoni-Villaret, Andrea Bianchetti, Chiara Ciccarese, Monica Mangoni, Laura Ferrari, Gianpaolo Biti, Mirella Marini, Vittorio D. Ferrari, Piero Nicolai, Stefano M. Magrini, Alfredo Berruti

23 Citations (Scopus)


Introduction: We investigated the frequency of detection and the prognostic and predictive significance of circulating tumor cells (CTCs) in patients with recurrent/metastatic (R/M) head and neck carcinoma (HNC) before starting systemic therapy. Patients and methods: Using the CellSearch technology, CTCs were assessed prospectively in peripheral blood of 53 R/M-HNC patients. We performed spiking experiments to test the diagnostic performance of the CellSearch platform in identifying squamous carcinoma cells. Results: CTCs were identified in 14 (26%) and 22 (41%) patients at baseline and at any time point, respectively. In univariate analysis ≥2 CTCs had a poorer prognostic role than 0-1 CTC. In multivariate analysis, the presence of one CTC or more was associated with a poor prognosis both in terms of progression-free survival (PFS) [Hazard Ratio (HR): 3.068, 95% confidence interval (CI): 1.53-6.13, p 0.002] and overall survival (OS) [HR: 3.0, 95% CI: 1.48-6.0, p 0.002]. A disease control after systemic therapy was obtained in 8% of CTC-positive patients as opposed to 45% in CTC-negative ones (p 0.03). The epidermal growth factor receptor (EGFR) expression was identified in 45% of CTC-positive patients. Discussion: In conclusion, CTCs are detected in one out of three patients with RM-HNC. CTC detection is a strong prognostic parameter and may be predictive of treatment efficacy. The frequency of EGFR expression in CTCs seems to be lower than that expected in the primary tumor.

Original languageEnglish
Article numbere103918
JournalPLoS ONE
Issue number8
Publication statusPublished - 08.08.2014


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