Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.138
Peer-review started: October 15, 2018
First decision: November 7, 2018
Revised: December 5, 2018
Accepted: December 6, 2018
Article in press: December 6, 2018
Published online: January 7, 2019
To evaluate the clinical properties of three subpopulations of circulating tumor cells (CTCs) undergoing epithelial-mesenchymal transition (EMT) in pancreatic ductal adenocarcinoma (PDAC) patients.
We identified CTCs for expression of the epithelial cell marker cytokeratin or epithelial cell adhesion molecule (EpCAM) (E-CTC), the mesenchymal cell markers vimentin and twist (M-CTC), or both (E/M-CTC) using the CanPatrol system. Between July 2014 and July 2016, 107 patients with PDAC were enrolled for CTC evaluation. CTC enumeration and classification were correlated with patient clinicopathological features and outcomes.
CTCs were detected in 78.5% of PDAC patients. The number of total CTCs ranged from 0 to 26 across all 107 patients, with a median value of six. CTC status correlated with lymph node metastasis, TNM stage, distant metastasis, blood lymphocyte counts, and neutrophil-to-lymphocyte ratio (NLR). Kaplan-Meier survival analysis showed that patients with ≥ 6 total CTCs had significantly decreased overall survival and progression-free survival compared with patients with < 6 total CTCs. The presence of M-CTCs was positively correlated with TNM stage (P < 0.01) and distant metastasis (P < 0.01). Additionally, lymphocyte counts and NLR in patients without CTCs were significantly different from those in patients testing positive for each CTC subpopulation (P < 0.01).
Classifying CTCs by EMT markers helps to identify the more aggressive CTC subpopulations and provides useful evidence for determining a suitable clinical approach.
Core tip: In the present study, circulating tumor cell (CTC) enumeration and classification in pancreatic ductal adenocarcinoma (PDAC) patients were examined using the CanPatrol system. We explored the relationship between CTC status and survival and prognosis in 107 PDAC patients in China. CTC status was correlated with lymph node metastasis, TNM stage, distant metastasis, blood lymphocyte counts, neutrophil-to-lymphocyte ratio, and patient prognosis. Our findings demonstrate that CTCs show promise as a prognostic biomarker and provide useful evidence for determining an appropriate clinical approach for pancreatic adenocarcinoma patients.