Abstract
BackgroundThe aim was to determine value of circulating tumor cells(CTCs) undergoing epithelial–mesenchymal transition(EMT) in risk stratification of epithelial ovarian cancer(EOC) recurrence.MethodsCTCs were prospectively analyzed among 118 patients with pathological diagnosed EOC from June 2017 to October 2019. We used CanPatrol CTC-enrichment technique to detect CTCs from blood samples and then classify their subpopulations into epithelial, mesenchymal and hybrids. To construct nomogram based on prognostic factors selected by Cox regression analysis, 88 patients were randomly assigned to a training group, and the rest 30 patients were included in external validation group. Risk stratification was performed through Kaplan–Meier survival analysis.ResultsBy multivariate regression screening, both CTC counts(HR, 1.187; 95%CI, 1.098-1.752; p=0.012) and M-CTC(HR, 1.098; 95%CI, 1.047-1.320; p=0.009) were demonstrated as independent prognosis factors for EOC recurrence. Apart from CTCs, other variables including pathological grade, FIGO stage, lymph node metastasis, ascites and CA-125 were also collected(p < 0.005) to construct nomogram. The C-index of the internal and external validation for nomogram was 0.913 and 0.874. The AUC of ROC curves for nomogram with/without CTCs was 0.8705 and 0.8097, taking CTC counts and M-CTC into separation, the values were 0.8075 and 0.8262. Finally, the survival curves of risk stratification based on CTC counts(p=0.0241), M-CTC(p=0.0107), nomogram with(p=0.0021) and without(p=0.0002) CTCs were drawn with significant difference.ConclusionOverall, CTCs could serve as a novel factor for EOC prognosis. Nomogram model constructed by CTC counts, M-CTC and other clinical parameters could predict EOC recurrence and perform risk stratification for clinical decision-making.