ArticleCancer management and research2026
Analyzing the Influence of Surgical Sequence on Perioperative Circulating Tumor Cells in Patients with Resectable Non-Small Cell Lung Cancer.
Article in Cancer management and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the impact of different surgical sequences on perioperative dynamic changes in circulating tumor cells (CTCs) in patients with resectable non-small cell lung cancer (NSCLC). Methods: A total of 60 patients with resectable NSCLC were prospectively enrolled in this single-center, non-randomized observational study and divided into the lung-first group (n = 33) and the lymph node-first group (n = 27) according to surgical sequence. Results: CTCs were detected in 97.5% of perioperative blood samples. In the overall cohort, total CTC counts did not differ significantly before and after surgery. However, surgical sequence was associated with distinct perioperative CTC dynamics. In the lung-first group, postoperative CTC counts were significantly lower than preoperative levels (median, 9 vs. 13 cells/5 mL; P = 0.007), whereas CTC counts increased significantly after surgery in the lymph node-first group (median, 20 vs. 9 cells/5 mL; P < 0.001). At the individual-patient level, CTC counts decreased in 66.7% of patients in the lung-first group, whereas they increased in 88.9% of patients in the lymph node-first group (P < 0.001). Postoperatively, the lung-first group showed a higher proportion of epithelial CTCs and a lower proportion of hybrid CTCs. Higher postoperative CTC counts were associated with pleural adhesion, lymphovascular invasion, and higher consolidation-to-tumor ratio. Conclusion: Perioperative CTC dynamics in NSCLC are influenced by surgical sequence and clinicopathological characteristics. Prioritizing lung tumor resection before lymph node dissection may be associated with reduced perioperative CTC dissemination and a more favorable CTC phenotype; however, these preliminary findings require validation in larger prospective randomized studies.
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