Survivin mRNA-circulating tumor cells predict treatment efficacy of chemotherapy and survival for advanced non-small cell lung cancer patients

The purpose of this prospective study was to evaluate the prognostic and predictive value of survivin mRNA-circulating tumor cells (CTCs) in peripheral blood of patients with advanced non-small cell lung cancer (NSCLC) who received first-line chemotherapy. Blood samples were collected from 78 patients with stage IIIB and IV NSCLC before (C0) and after 1 cycle (C1) and 3 cycles (C3) of chemotherapy. Survivin mRNA-CTCs were detected by real-time quantitative-PCR and correlated with treatment response and survival. The results showed that the presence of survivin mRNA-CTCs before and during chemotherapy was associated with histology type, tumor stage, and number of sites of metastasis. Moreover, the detection of survivin mRNA-CTCs after 1 and 3 cycles of chemotherapy was significantly associated with imaging response to treatment. Patients with positivity for survivin mRNA-CTCs at C0, C1, and C3 time points had significantly shorter progressive-free survival (PFS) and overall survival (OS) compared with patients without. Multivariate analysis using a Cox proportional hazards model revealed that the presence of survivin mRNA-CTCs after one and three chemotherapy cycles was a significant independent factor for worse PFS and OS. In conclusion, the detection of survivin mRNA-CTCs before and during chemotherapy is a prognostic and predictive factor correlated with poor PFS and OS in patients with advanced NSCLC.