Krążące komórki nowotworowe guzów litych – klucz do nowej klasyfikacji stopnia zaawansowania raków układu moczowo-płciowego
Circulating tumour cells of solid tumours – a key to the novel clinical staging of genito-urinary neoplasms
Circulating Tumour Cells (CTC) are a population of cells that have detached from the tumour mass and are able to disseminate via the vascular system and create metastatic foci in the body (1). Initially, the immune system eliminates the circulating cancer cells from the bloodstream, but over time, the cells remain there for longer periods and become identifiable. The first published report of circulating tumour cells dates back to 1869 (2).
The circulating cells acquire properties of mesechymal cells, i.e. they are able to function independently. This is known as Epithelial to Mesenchymal Transition (EMT) (6). As a result of changes in their adhesion molecules, the cells separate from the primary cell population and gain the ability to migrate independently within the extracellular matrix and, eventually, outside it (7). The reverse process, known as Mesenchymal to Epithelial Transition (MET), is one of the most important stages of the development of cancer metastases. Armstrong et al. demonstrated that 80% of circulating cells of prostate or breast cancer express mesenchymal and epithelial markers (8). The authors suggested that the ratio of these markers could be a valuable prognostic parameter.
Circulating cancer cells are gradually gaining importance in clinical medicine. Many studies have especially been published on the subject of prostate cancer, where authors underscore the potential role of CTC in the prediction of survival and treatment outcomes. The presence of CTC in the patient’s bloodstream is consistent with disease that is refractory to a given treatment, which therefore requires modification (9). It has been demonstrated in an animal model that approximately 10 CT cells are sufficient to develop a new tumour in the case of renal or prostate cancer (10). Identifying CTC may in future help to discern patients who, according to standard diagnostic methods, are not qualified to undergo further radical treatment due to unfavourable prognosis regarding cure (11).
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