Circulating tumor cells dynamics in pancreatic adenocarcinoma correlate with disease status: Results of the prospective cluster study

Gemenetzis, Georgios; Groot, Vincent P.; Yu, Jiwei; Teinor, Jonathan A.; Javed, Ammar A.; Wood, Laura D.; Burkhart, Richard A.; Cameron, John L.; Makary, Martin A.; Weiss, Matthew J.; He, Jié; Wolfgang, C.

doi:10.1016/j.hpb.2019.03.002

Cited by 25 publications

(29 citation statements)

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“…Smaller series have also correlated age, tumor size, unintentional weight loss, jaundice and diarrhea, CA 19‐9, and inflammatory markers as OMD predictors. Moreover, circulating tumor cells show promise as a preoperative biomarker for identifying patients at high risk of OMD, as two recent studies showed significantly elevated preoperative numbers of circulating tumor cells in patients with OMD when compared with non‐OMD patients …”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Gemenetzis

Groot

Blair

et al. 2018

Journal of Surgical Oncology

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Background The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. Methods We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10‐year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. Results In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non‐OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19‐9 (CA 19‐9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non‐OMD patients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19‐9 > 192 U/mL. Conclusions Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19‐9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Gemenetzis

Groot

Blair

et al. 2018

Journal of Surgical Oncology

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“…3,4 Due to late presentation and early metastasis, PC is largely diagnosed at an advanced stage, and therefore, the prognosis generally is poor. 5 Early diagnosis is mostly hampered by the lack of serum biomarkers with high diagnostic sensitivity and specificity. 6 Carbohydrate antigen (CA19-9) currently is the only biomarker approved by the United States Food and Drug Administration (FDA) and is widely used in clinical practice; however, it is insufficiently sensitive for early diagnostic screening and non-specific, as CA19-9 levels are elevated in a number of benign pancreatic and biliary diseases.…”

Section: Introductionmentioning

confidence: 99%

Ligand‐targeted polymerase chain reaction for the detection of folate receptor‐positive circulating tumour cells as a potential diagnostic biomarker for pancreatic cancer

Cheng

He²,

Yang

et al. 2020

Cell Proliferation

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Objectives To detect folate receptor (FR)‐positive circulating tumour cells (FR+ CTCs) by using ligand‐targeted polymerase chain reaction (LT‐PCR) in periampullary cancer patients and to investigate the diagnostic value of FR+ CTCs in distinguishing pancreatic cancer (PC) from benign pancreatic disease. Materials and Methods CTCs were enriched from 3 mL of peripheral blood and portal vein blood by immunomagnetic depletion of leucocytes and were then detected by LT‐PCR. The diagnostic performance of FR+ CTCs in PC was investigated by receiver‐operating characteristic curve analysis. Results In total, 57 consecutive patients, including 46 patients with PC, five patients with non‐pancreatic periampullary cancer (non‐PC) and six patients with benign pancreatic diseases, were enrolled. FR+ CTC levels were significantly higher in patients with malignant diseases (PC and non‐PC) than in patients with benign pancreatic diseases (P < .01). There was no notable difference in CTC levels between patients with PC and those with non‐PC (P > .05). The combination of FR+ CTCs with carbohydrate antigen 19‐9 (CA19‐9) had better diagnostic efficiency than each of these two markers alone, with high sensitivity (97.8%) and specificity (83.3%). Conclusions LT‐PCR is feasible and reliable for detecting FR+ CTCs in patients with periampullary cancer. FR+ CTCs, especially when used in combination with CA19‐9, have potential as a biomarker for the diagnosis of PC.

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“…Oncologists should also use biomarkers, such as changes in the CA 19-9 level [20], neutrophil-tolymphocyte ratio [32], and liquid biopsies [33][34][35] to propose tailored treatment after restaging among patients with no evidence of metastatic disease.…”

Section: Continuing With Chemotherapy or Crt At Restagingmentioning

confidence: 99%

Outcomes of patients with initially locally advanced pancreatic adenocarcinoma who did not benefit from resection: a prospective cohort study

et al. 2020

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Background: The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods: Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan-Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results: FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR) = 1.2, 95% confidence interval: 0.86-1.6, P = .03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0-1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR = 1.38, 95% confidence interval: 1-1.9, P < .01) and limited short-term treatment-related toxicity. Conclusions: The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease.

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Circulating tumor cells dynamics in pancreatic adenocarcinoma correlate with disease status: Results of the prospective cluster study

Cited by 25 publications

References 0 publications

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Ligand‐targeted polymerase chain reaction for the detection of folate receptor‐positive circulating tumour cells as a potential diagnostic biomarker for pancreatic cancer

Outcomes of patients with initially locally advanced pancreatic adenocarcinoma who did not benefit from resection: a prospective cohort study

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