Clinical Significance Of Circulating Tumor Cells (CTCs) And Circulating Tumor Vascular Endothelial Cells (CTECs) In The Evaluation Of The Efficacy Of Neoadjuvant Chemotherapy For Breast Cancer

Objective:It is proposed to conduct peripheral blood CTC/CTEC detection in breast cancer patients requiring neoadjuvant chemotherapy by SE-i FISH method,explore the relationship between the number of CTCs/CTECs and clinicopathological features before neoadjuvant chemotherapy,observe the changes in the number of CTCs/CTECs,and evaluate the efficacy of neoadjuvant chemotherapy according to this feature.Methods:According to the inclusion criteria and exclusion criteria,5m L of peripheral blood of patients diagnosed with breast cancer who required neoadjuvant chemotherapy in the Department of Breast Surgery of the Affiliated People’s Hospital of Inner Mongolia Medical University from December 2021to December 2022 was collected,and CTC/CTEC was detected by SE-i FISH.At the time of interpretation,three pathologists independently scanned the slides using fluorescence microscopy and recorded the values,and the number of CTCs≥3 as CTC positive and the number of CTEC≥1 as CTEC positive.Changes in the number of CTCs/CTECs before and after neoadjuvant chemotherapy were compared using nonparametric tests.The comparison of CTC detection and CTEC detection with the gold standard was Mc Nemar test,and the Kappa test was used for the consistency analysis with the gold standard,respectively,and the sensitivity and specificity were used to evaluate respectively.Results:More CTCs were detected in HER-2-positive patients（Z=-2.572,P=0.010）,and more CTCs were detected in15%of patients with ki-67 expression>（Z=-2.526,P=0.012）.Prior to neoadjuvant chemotherapy,the detection of CTC was not related to the patient’s age,menopausal or PR status（P>0.05）,but to tumor size（Z=-3.070,P=0.002）and ER status（Z=-3.017,P=0.003）,which may be due to insufficient sample size.The number of CTC tests decreased from M(P₂₅,P₇₅)=3（2,5）before neoadjuvant chemotherapy to M(P₂₅,P₇₅)=1（0.25,1.75）after neoadjuvant chemotherapy,and the significant decrease in the number of CTCs could indicate that this treatment had obvious efficacy（Z=-6.340,P<0.001）;the number of CTEC tests decreased from M(P₂₅,P₇₅)=3（1,3）before neoadjuvant chemotherapy to M(P₂₅,P₇₅)=0（0,0）,the significant decrease in the number of CTECs also indicated that this treatment was also effective（Z=-7.142,P<0.001）.Taking the pathology Miller-Payne criterion as the gold standard,18 cases were evaluated effectively and 22 cases were ineffective.There were 24cases of effective CTC detection and 16 cases of ineffective evaluation,and the sensitivity of CTC detection was 77.78%,and the specificity was 54.55%,and there was no statistical difference between the two methods of evaluating efficacy（P=0.180）,and the two evaluations were inconsistent（Kappa=0.314,P<0.05）.Among the CTEC tests,35 cases were evaluated effectively,5 cases were ineffective,the sensitivity of CTEC detection was 94.44%,the specificity was 18.18%,and there were statistical differences in the methods of evaluating efficacy between the two（P<0.001）,and the consistency of the two evaluations was weak（Kappa=0.116,P>0.05）.Conclusion:Prior to neoadjuvant chemotherapy,the detection of CTCs was independent of the patient’s age,menopausal status,and PR status,but rather tumor size and ER status,which may have been due to insufficient sample size.The detection of CTCs correlated with the status of HER-2 and the expression of ki-67.The detection of CTEC is not related to the above indicators.Changes in the number of CTCs/CTECs correlated with the efficacy of neoadjuvant chemotherapy.CTC testing can assess the efficacy of neoadjuvant chemotherapy to some extent;The detection of CTEC needs to be confirmed experimentally,and this test cannot be used to evaluate the efficacy of neoadjuvant chemotherapy.