In vivo detection demonstrates circulating tumor cell reduction instead of baseline number has prognostic value in bladder cancer patients receiving neoadjuvant chemotherapy

Purpose: Previous studies have suggested the potential prognostic value of circulating tumor cells (CTCs) in bladder cancer (BC) patients. This study aims to validate the prognostic value of in vivo detection of CTCs in muscle invasive bladder cancer (MIBC) patients receiving neoadjuvant chemotherapy (NAC).

Methods: A total of 107 MIBC patients were enrolled in this study. All patients had one in vivo detection of CTCs before initial treatment as baseline, and those who received neoadjuvant chemotherapy (NAC) had a second detection after NAC and before radical cystectomy. CTCs dynamic change after NAC was analyzed. Prognostic value of in vivo CTCs detection was investigated.

Results: Among 68 patients who received NAC, 45 patients (66%) had a CTC reduction after NAC. CTC reduction instead of baseline CTC positivity was a key prognostic factor for better progression free survival (PFS) among all MIBC patients receiving NAC in Kaplan-Meier analysis (P < 0.01) and in both crude (HR 6.14, 95%CI 1.63-23.21) and adjusted regression model (HR 6.76, 95% CI 1.59-28.88). The AUC was 0.85.

Conclusion: Our study demonstrated the prognostic value of in vivo detection of CTCs. The dynamic change of CTCs count may help evaluate the efficacy of NAC.