Circulating Tumor Cell Detection by Liquid Biopsy during Early-Stage Endometrial Cancer Surgery: A Pilot Study

Abstract

The recurrence of non-metastatic endometrial carcinoma (EC) (6 to 21%) might be due to disseminated tumor cells. This feasibility study investigated whether circulating tumor cells (CTCs) were detectable in blood samples from the peripheral and ovarian veins of 10 patients undergoing laparoscopic resection of stage I-II EC between July 2019 and September 2021. CTCs were detected using the CellSearch® system (i) preoperatively (T0) in peripheral blood, (ii) after ovary suspensory ligament pediculation in ovarian vein blood (T1), and (iii) before colpotomy in peripheral blood (T2). CTCs were detected only in ovarian vein samples in 8/10 patients. The CTC median number did not differ with patient age (37 (min-max: 0–91) in <70-year-old vs. 11 (0–65) in ≥70 year-old women, p = 0.59), tumor grade (15 (0–72) for grade 1 vs. 15 (0–91) for grade 2, p = 0.97), FIGO stage (72 (27–91) vs. 2 (0–65) vs. 3 (0–6]) for stage IA, B, and II, respectively; p = 0.08), and tumor size (40 (2–72) for size < 30 mm vs. 4 (0–91) for size ≥ 30 mm, p = 0.39). Estrogen receptor-positive CTCs and CTC clusters were identified. The prognostic and therapeutic values of CTCs released during EC surgery need to be determined.

Hsp70—A Universal Biomarker for Predicting Therapeutic Failure in Human Female Cancers and a Target for CTC Isolation in Advanced Cancers

“…However, the rarity of this cell type in the peripheral blood and the loss of EpCAM expression on CTCs after EMT limits the capacity of EpCAM mAb-based approaches to effectively isolate CTCs [ 47 ]. Herein, we demonstrated that a CTC isolation system that targets mHsp70 on tumor cells [ 27 ] is superior to an EpCAM mAb-based system since at least equal, but mostly higher numbers of CTCs could be isolated from the peripheral blood of patients with metastatic prostate cancer who received a [ 177 Lu]-PSMA-radioligand therapy later on [ 49 ], endometrial carcinoma [ 50 ], lung and squamous cell carcinoma of the head and neck. Moreover, elevated circulating Hsp70 levels in the blood, which are most likely derived from Hsp70 that is actively released in extracellular lipid micro-vesicles from viable tumor cells [ 21 ], do not negatively affect the mHsp70-targeted CTC isolation process.…”

The Role of Circulating Tumor Cells as a Liquid Biopsy for Cancer: Advances, Biology, Technical Challenges, and Clinical Relevance

“…The evolving field of liquid biopsy has significantly benefited from these insights into CTC clusters. Progress in microfluidics and other isolation technologies has made it feasible to selectively isolate CTCs as either individual cells or clusters [31,44,83,87,88]. This advancement is crucial for making clinically relevant assessments about cancer progression and guiding treatment strategies.…”

“…Future research in this area is likely to focus on refining techniques for simultaneous biomarker analysis and developing integrated platforms that can provide comprehensive cancer profiling from liquid biopsies. Clinical trials are also needed to validate the clinical utility of multi-marker analysis in guiding treatment decisions and improving patient outcomes [19,49,51,87].…”