The predictive value of folate receptor-positive circulating tumor cells in patients with resectable stage Ⅲ squamous cell carcinoma after neoadjuvant chemotherapy combined with immunotherapy
Objective To investigate the predictive value of folate receptor-positive circulating tumor cells(FR+-CTCs)in determining the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stage Ⅲ squamous cell carcinoma.Methods A total of patients diagnosed with resectable stage Ⅲ squamous cell carcinoma and admitted to Beijing Chest Hospital from June 2021 to June 2023 were included in this study.After receiving 2 cycles of neoadjuvant chemotherapy combined with immunotherapy,the following parameters were recorded:① general clinical data including age,gender,clinical stage,tumor location,pre-and post-treatment white blood cell count;② levels of tumor markers such as serum carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA 21-1),squamous cell carcinoma antigen(SCC),and FR+-CTCs before and after treatment;③ postoperative pathological results,based on which the patients were divided into two groups:group E(<10%residual tumor cells)and NE group(>10%residual tumor cells).Binary Logistic regression analysis was performed using general clinical data,white blood cell count,tumor marker data,and FR+-CTCs data before and after treatment to statistically analyze factors influencing the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stage Ⅲ squamous cell carcinoma.The predictive value of FR+-CTCs was assessed using receiver operating characteristics(ROC)curve analysis.Results A total of 24 patients were included in this study,with 15 patients in group E and 9 patients in the NE group.There were no significant differences observed between the two groups regarding general clinical data or pre-treatment levels of CEA,CYFRA 21-1,SCC or FR+-CTCs(P>0.05).Additionally,no statistically significant differences were found for CEA,CYFRA21-1,and SCC levels after treatment.FR+-CTCs in group E was significantly lower than that in group NE(P<0.05).Binary Logistic regression analysis showed that FR+-CTCs after treatment(OR=1.28,95%CI:1.00-1.63,P=0.047)was the influencing factor of neoadjuvant chemotherapy combined with immunotherapy.ROC analysis showed that the cut-off value of FR+-CTCs after treatment was 10.10,with a specificity of 0.87,a sensitivity of 0.89,and an area under the curve of 0.837.Conclusion For patients with resectable Ⅲ squamous cell carcinoma,FR+-CTCs after treatment lower than 10.10 FU/3 mL can predict the remission effect of neoadjuvant chemotherapy combined with immunotherapy.
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