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Circulating Tumor Cells Predict Occult Metastatic Disease and Prognosis in Pancreatic Cancer.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2018 Apr; Vol. 25 (4), pp. 1000-1008. Date of Electronic Publication: 2018 Feb 13. - Publication Year :
- 2018
-
Abstract
- Background: Occult metastatic tumors, below imaging thresholds, are a limitation of staging systems that rely on cross-sectional imaging alone and are a cause of the routine understaging of pancreatic ductal adenocarcinomas (PDACs). We investigated circulating tumor cells (CTCs) as a preoperative predictor of occult metastatic disease and as a prognostic biomarker for PDAC patients.<br />Experimental Design: A total of 126 patients (100 with cancer, 26 with benign disease) were enrolled in our study and CTCs were identified and enumerated from 4 mL of venous blood using the microfluidic NanoVelcro assay. CTC enumeration was correlated with clinicopathologic variables and outcomes following both surgical and systemic therapies.<br />Results: CTCs were identified in 78% of PDAC patients and CTC counts correlated with increasing stage (ρ = 0.42, p < 0.001). Of the 53 patients taken for potentially curative surgery, 13 (24.5%) had occult metastatic disease intraoperatively. Patients with occult disease had significantly more CTCs than patients with local disease only (median 7 vs. 1 CTC, p < 0.0001). At a cut-off of three or more CTCs/4 mL, CTCs correctly identified patients with occult metastatic disease preoperatively (area under the receiver operating characteristic curve 0.82, 95% confidence interval (CI) 0.76-0.98, p < 0.0001). CTCs were a univariate predictor of recurrence-free survival following surgery [hazard ratio (HR) 2.36, 95% CI 1.17-4.78, p = 0.017], as well as an independent predictor of overall survival on multivariate analysis (HR 1.38, 95% CI 1.01-1.88, p = 0.040).<br />Conclusions: CTCs show promise as a prognostic biomarker for PDAC patients at all stages of disease being treated both medically and surgically. Furthermore, CTCs demonstrate potential as a preoperative biomarker for identifying patients at high risk of occult metastatic disease.
- Subjects :
- Aged
Carcinoma, Pancreatic Ductal blood
Carcinoma, Pancreatic Ductal surgery
Female
Follow-Up Studies
Humans
Liver Neoplasms blood
Liver Neoplasms surgery
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local blood
Neoplasm Recurrence, Local surgery
Pancreatectomy
Pancreatic Neoplasms blood
Pancreatic Neoplasms surgery
Peritoneal Neoplasms blood
Peritoneal Neoplasms surgery
Prognosis
Prospective Studies
Survival Rate
Biomarkers, Tumor blood
Carcinoma, Pancreatic Ductal secondary
Liver Neoplasms secondary
Neoplasm Recurrence, Local pathology
Neoplastic Cells, Circulating pathology
Pancreatic Neoplasms pathology
Peritoneal Neoplasms secondary
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 25
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 29442211
- Full Text :
- https://doi.org/10.1245/s10434-017-6290-8