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Circulating tumour cells and outcome in non-metastatic colorectal cancer: a prospective study.

Bork U, Rahbari NN, Schölch S, Reissfelder C, Kahlert C, Büchler MW, Weitz J, Koch M - Br. J. Cancer (2015)

Bottom Line: No clinicopathological variables were associated with CTC detection in non-metastatic patients.CTC detection (⩾1 CTC per 7.5 ml blood) in the blood was significantly associated with worse overall survival (49.8 vs 38.4 months; P<0.001) in the non-metastatic group (UICC I-III), as well as in the complete cohort (48.4 vs 33.6 months; P<0.001).Preoperative CTC detection is a strong and independent prognostic marker in non-metastatic CRC.

View Article: PubMed Central - PubMed

Affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.

ABSTRACT

Background: Circulating tumour cells (CTC) in the blood have been accepted as a prognostic marker in patients with metastatic colorectal cancer (CRC). Only limited data exist on the prognostic impact of CTC in patients with early stage CRC using standardised detection assays. The aim of this study was to elucidate the role of CTC in patients with non-metastatic CRC.

Methods: A total of 287 patients with potentially curable CRC were enrolled, including 239 patients with UICC stage I-III. CTC were measured in the blood using the CellSearch system preoperatively and on postoperative days 3 and 7. The complete patient group (UICC I-IV) and the non-metastatic cohort (UICC I-III) were analysed independently. Patients were followed for 28 (0-53) months. Prognostic factors for overall and progression-free survival were analysed using univariate and multivariate analyses.

Results: CTC were detected more frequently in patients with metastatic disease. No clinicopathological variables were associated with CTC detection in non-metastatic patients. CTC detection (⩾1 CTC per 7.5 ml blood) in the blood was significantly associated with worse overall survival (49.8 vs 38.4 months; P<0.001) in the non-metastatic group (UICC I-III), as well as in the complete cohort (48.4 vs 33.6 months; P<0.001). On multivariate analysis CTC were the strongest prognostic factor in non-metastatic patients (hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.3-13.6) as well as in the entire study group (HR 5.6; 95% CI 2.6-12.0).

Conclusions: Preoperative CTC detection is a strong and independent prognostic marker in non-metastatic CRC.

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Related in: MedlinePlus

Detection rate and count of CTC. (A–C) Stage-dependent detection rate of CTC with a threshold of ⩾1 (A), ⩾2 (B) and ⩾3 (C) CTC. (D) Stage-dependent detection count of CTC. (E and F) Perioperative detection of ⩾1 CTC in UICC stage I–III (E) and stage I–IV (F) patients.
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fig1: Detection rate and count of CTC. (A–C) Stage-dependent detection rate of CTC with a threshold of ⩾1 (A), ⩾2 (B) and ⩾3 (C) CTC. (D) Stage-dependent detection count of CTC. (E and F) Perioperative detection of ⩾1 CTC in UICC stage I–III (E) and stage I–IV (F) patients.

Mentions: In the analysis of preoperative blood samples, ⩾1 CTC per 7.5 ml of blood were found in 30 patients (10.5%), ⩾2 CTC in 9 patients (3.1%) and ⩾3 more CTC in 5 patients (1.7%) (Supplementary Table 1). Detection rate of CTC was significantly correlated with the stage of disease comparing non-metastatic and metastatic patients with 3 (4.9%), 9 (10.5%), 7 (8.3%) and 9 (18.8%) patients with ⩾1 detected CTC in UICC stages I, II, III and IV, respectively (P=0.03). The stage-dependent CTC detection with increased detection rates for patients with UICC IV disease was confirmed for detection of ⩾2 (P=0.001) or ⩾3 (P=0.008) CTC per 7.5 ml of blood (Figure 1). Furthermore, patients' stage of disease was associated significantly with the number of CTC in peripheral blood detected intraoperatively. Postoperative blood samples with CTC analyses on postoperative days 3 and 7 were carried out in 51 and 28 patients, respectively. In the UICC I–III group ⩾1 CTC was detected on postoperative days 3 and 7 in 4 (10.0%) and 3 (14.3%) patients, whereas in the UICC stage I–IV group 9 (17.6%) and 6 (21.4%) patients had detectable CTC.


Circulating tumour cells and outcome in non-metastatic colorectal cancer: a prospective study.

Bork U, Rahbari NN, Schölch S, Reissfelder C, Kahlert C, Büchler MW, Weitz J, Koch M - Br. J. Cancer (2015)

Detection rate and count of CTC. (A–C) Stage-dependent detection rate of CTC with a threshold of ⩾1 (A), ⩾2 (B) and ⩾3 (C) CTC. (D) Stage-dependent detection count of CTC. (E and F) Perioperative detection of ⩾1 CTC in UICC stage I–III (E) and stage I–IV (F) patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4402459&req=5

fig1: Detection rate and count of CTC. (A–C) Stage-dependent detection rate of CTC with a threshold of ⩾1 (A), ⩾2 (B) and ⩾3 (C) CTC. (D) Stage-dependent detection count of CTC. (E and F) Perioperative detection of ⩾1 CTC in UICC stage I–III (E) and stage I–IV (F) patients.
Mentions: In the analysis of preoperative blood samples, ⩾1 CTC per 7.5 ml of blood were found in 30 patients (10.5%), ⩾2 CTC in 9 patients (3.1%) and ⩾3 more CTC in 5 patients (1.7%) (Supplementary Table 1). Detection rate of CTC was significantly correlated with the stage of disease comparing non-metastatic and metastatic patients with 3 (4.9%), 9 (10.5%), 7 (8.3%) and 9 (18.8%) patients with ⩾1 detected CTC in UICC stages I, II, III and IV, respectively (P=0.03). The stage-dependent CTC detection with increased detection rates for patients with UICC IV disease was confirmed for detection of ⩾2 (P=0.001) or ⩾3 (P=0.008) CTC per 7.5 ml of blood (Figure 1). Furthermore, patients' stage of disease was associated significantly with the number of CTC in peripheral blood detected intraoperatively. Postoperative blood samples with CTC analyses on postoperative days 3 and 7 were carried out in 51 and 28 patients, respectively. In the UICC I–III group ⩾1 CTC was detected on postoperative days 3 and 7 in 4 (10.0%) and 3 (14.3%) patients, whereas in the UICC stage I–IV group 9 (17.6%) and 6 (21.4%) patients had detectable CTC.

Bottom Line: No clinicopathological variables were associated with CTC detection in non-metastatic patients.CTC detection (⩾1 CTC per 7.5 ml blood) in the blood was significantly associated with worse overall survival (49.8 vs 38.4 months; P<0.001) in the non-metastatic group (UICC I-III), as well as in the complete cohort (48.4 vs 33.6 months; P<0.001).Preoperative CTC detection is a strong and independent prognostic marker in non-metastatic CRC.

View Article: PubMed Central - PubMed

Affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.

ABSTRACT

Background: Circulating tumour cells (CTC) in the blood have been accepted as a prognostic marker in patients with metastatic colorectal cancer (CRC). Only limited data exist on the prognostic impact of CTC in patients with early stage CRC using standardised detection assays. The aim of this study was to elucidate the role of CTC in patients with non-metastatic CRC.

Methods: A total of 287 patients with potentially curable CRC were enrolled, including 239 patients with UICC stage I-III. CTC were measured in the blood using the CellSearch system preoperatively and on postoperative days 3 and 7. The complete patient group (UICC I-IV) and the non-metastatic cohort (UICC I-III) were analysed independently. Patients were followed for 28 (0-53) months. Prognostic factors for overall and progression-free survival were analysed using univariate and multivariate analyses.

Results: CTC were detected more frequently in patients with metastatic disease. No clinicopathological variables were associated with CTC detection in non-metastatic patients. CTC detection (⩾1 CTC per 7.5 ml blood) in the blood was significantly associated with worse overall survival (49.8 vs 38.4 months; P<0.001) in the non-metastatic group (UICC I-III), as well as in the complete cohort (48.4 vs 33.6 months; P<0.001). On multivariate analysis CTC were the strongest prognostic factor in non-metastatic patients (hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.3-13.6) as well as in the entire study group (HR 5.6; 95% CI 2.6-12.0).

Conclusions: Preoperative CTC detection is a strong and independent prognostic marker in non-metastatic CRC.

Show MeSH
Related in: MedlinePlus