Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7921-7928
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7921
Monitoring disease progression and treatment efficacy with circulating tumor cells in esophageal squamous cell carcinoma: A case report
Yuan-Yuan Qiao, Kai-Xuan Lin, Ze Zhang, Da-Jin Zhang, Cheng-He Shi, Ming Xiong, Xiu-Hua Qu, Xiao-Hang Zhao
Yuan-Yuan Qiao, Da-Jin Zhang, Cheng-He Shi, Ming Xiong, Xiu-Hua Qu, Xiao-Hang Zhao, Center for Basic Medical Sciences, Navy General Hospital of Chinese PLA, Beijing 100048, China
Kai-Xuan Lin, Ze Zhang, Graduate School of Southern Medical University, Guangzhou 510515, Guangdong Province, China
Xiao-Hang Zhao, State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Qiao YY, Lin KX and Zhang Z performed the majority of the research work and wrote the manuscript; Xiong M and Qu XH assisted in the experiments and data analysis; Zhang DJ, Shi CH and Zhao XH were supervisors for this work; Zhao XH designed the study.
Supported by Grants from the High-tech R and D Program, No. 2012AA020206, No. 2014CBA02002, and No. 2013ZX10002009-001-004; State Key Projects for Basic Research, No. 2011CB910703; National Natural Science Foundation of China, No. 81372591 and No. 81321091; and the Center for Marine Medicine and Rescue of Tsinghua University of China.
Ethics approval: The study was reviewed and approved by the Navy General Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no competing financial interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Xiao-Hang Zhao, PhD, State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China.
Telephone: +86-10-66951482 Fax: +86-10-87778360
Received: December 3, 2014
Peer-review started: December 5, 2014
First decision: December 26, 2014
Revised: January 11, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: July 7, 2015

This study investigated whether changes in circulating tumor cell (CTC) numbers reflect tumor progression and treatment efficacy in esophageal squamous cell carcinoma (ESCC). A 47-year-old male patient with ESCC is presented in this case study. The patient was evaluated for a series of serum tumor markers and subjected to radiological examinations before and after surgery and during follow-up over the course of five years. In addition, the CTCs in 7.5 mL of peripheral blood were enriched by magnetic-activated cell sorting negative selection and identified by immunofluorescence staining. Serum tumor markers remained within normal ranges and were discordant with imaging scans during the follow-up. Initially, one CTC was detected in the peripheral blood sample, and 14 were observed seven days after the operation. After 12 wk, subcutaneous metastases and bone metastases occurred, and the number of CTCs increased to 84. After 48 wk, lung metastases were noted, and the CTC level was 21. At 104 wk, the number of CTCs was 14, and disease recurrence was detected by positron emission tomography-computed tomography. The CTC counts were in accord with the imaging studies at several time points. The additional information provided by CTC enumeration could thus facilitate monitoring of disease status and treatment efficacy and provide support for treatment decisions.

Keywords: Individualized treatment, Adjuvant therapy, Esophageal squamous cell carcinoma, Circulating tumor cells

Core tip: We report a follow-up of a 47-year-old male patient with esophageal squamous cell carcinoma in this study. In addition to the conventional examination, a novel workflow was performed to detect circulating tumor cells (CTCs). We evaluated the relationship between CTC characteristics and other tests. The serum tumor markers were normal and thus did not appear to reflect changes in the disease, whereas the number of CTCs fluctuated with the disease progression and treatment and coincided with imaging studies performed during the follow-up. This case highlights CTCs as a useful diagnostic tool with potential applications during treatment.