Fig. 4

Comparison of total CTC count, CTC phenotype, serum tumor markers, and radiographic examination in identifying disease progression. a For patient No. 01058, the M + CTC count and their proportion in total CTCs manifested a continuous declining tendency and the total CTC count was fluctuated when the patient responded to chemotherapy. Moreover, when disease progression presented in the liver and pleura, the count and proportion of M + CTCs increased significantly compared with the prior measurement, while the total CTC count and the level of CA153 continued to descend. b For patient No. 01131, the total CTC count and M + CTC count were obviously increased 3 months earlier than the imaging evidence of disease progression. CTC circulating tumor cell; E + CTCs epithelial CTCs, E +/M + CTCs biphenotypic epithelial/mesenchymal CTCs, M + CTCs mesenchymal CTCs, CA153 carbohydrate antigen 153, CEA carcinoembryonic antigen, PR partial response, SD stable disease, PD progressive disease. The arrows and circles on the radiographic image were used to indicate the lesions