Diagnostic and Predictive Value of CD133-Positive Circulating Tumor Cells as an Indicator of Pathological High-Risk Factors for Stage I Non-Small Cell Lung Cancer.

BACKGROUND: The noninvasive prediction of pathological high-risk factors in stage I NSCLC patients before surgery remains an area for further investigation, and circulating stem cancer cells are a potential predictive diagnostic indicator. Identifying these factors preoperatively can guide treatment decisions and may improve outcomes. Here, we aim to explore CD133-positive circulating tumor cells (CTCs) in stage I patients of NSCLC to predict pathological high-risk factors of patients, thereby aiding clinical decision-making. METHODS: A total of 192 Stage I NSCLC patients were finally enrolled and underwent surgical intervention. We assessed the level of CD133-positive CTCs by employing the telomerase reverse Transcriptase-Based CTC Detection method. The Least Absolute Shrinkage and Selection Operator method (LASSO) and logistic regression were used to analyze the association between CD133-positive CTCs with pathological high-risk factors and construct a diagnostic model. RESULTS: Among all the enrolled patients, postoperative pathology confirmed that 12 patients had pathological high-risk factors, while 180 patients had no high-risk factors. The median count of CD133-positive CTCs before surgery in patients with high-risk factors was recorded at 1.58 ± 1.83, significantly higher than 0.767 ± 1.13 observed in the group without high-risk factors (p = 0.048). Following feature selection by LASSO regression and multivariate logistic regression, it was determined that CD133-positive CTCs, CT imaging nodule features, and elevated CEA levels can be combined as diagnostic indicators for pathological high-risk factors in NSCLC patients. The ROC curve derived from internal bootstrap validation, alongside the calibration and DCA plots, affirmed the model's accuracy and predictive capability. After follow-up, we found that patients without high-risk pathological factors showed better PFS (p = 0.044). CONCLUSIONS: This study indicated that CD133-positive CTCs were associated with pathological high-risk factors, and the detection of CD133-positive CTCs may assist treatment decision-making for patients of NSCLC.