Circulating Tumor Cells in Patients With Colorectal Liver Metastasis Predict Impaired Survival

Abstract

CTCs predict nonresectability and impaired survival. CTC analysis should be considered as a tool for decision-making before liver resection in these patients.

Central, But Not Peripheral, Circulating Tumor Cells are Prognostic in Patients Undergoing Resection of Colorectal Cancer Liver Metastases

“…30 Perhaps more surprisingly is what features were not prognostic. None of the clinical factors used in known [12][13][14][16][17][18][19][20][21][22] In addition, we did not validate neutrophil-to-lymphocyte ratio above 5 as associated with outcomes, although this has been shown in separate series. 31,32 Measurement of HV CTCs preoperatively by central venous catheterization is feasible but invasive and impractical for a single blood draw.…”

“…5,6 In this same context of resectable CRLMs, five studies have characterized CTCs in PV using either PCR-based or cell-surface-based techniques in small sample sizes, with mixed results. 12,16,19,22,23 A meta-analysis of all studies on circulating and disseminated tumor cells in patients with metastatic CRC reported that elevated levels by any measure were associated with worse outcomes for the palliative and curative intent groups combined, but the hazard ratios were not significant in the resectable subgroup alone, which was composed exclusively of CRLM cases. 10 The lack of consensus in these studies supports our finding that PV CTCs are not likely prognostic as a strong effect size would likely have been validated previously.…”

“…6 Their adverse prognostic value in peripheral blood has been validated in the early and palliative settings in primary breast, 7 prostate 8 and primary CRC, 9,10 implying that CTCs may be of prognostic value in CRLMs. There are many retrospective series [11][12][13][14][15][16][17][18][19][20][21][22][23] and one metaanalysis 10 on either circulating or disseminated (i.e., in bone marrow) tumor cell detection in resectable CRLMs. However, study methodologies and results are mixed, and more work is needed to clarify the role, if any, of CTCs in determining CRLM prognosis preoperatively.…”

Respiratory gated PET/CT of the liver: A novel method and its impact on the detection of colorectal liver metastases

“…Inclusion criteria were patients with histopathologically confirmed colorectal cancer and suspected synchronous or metachronous CRLM who were referred for liver resection at our institution. The CRLM had to be preliminary considered resectable, defined as feasible R0 or R1-resection (resection of all CRLM with macroscopic tumor-free resection margins) with a sufficient liver remnant [14][15][16]. A multidisciplinary team including liversurgeons, oncologists and radiologists determined a preliminary treatment-strategy and resectability based on clinical information and CT findings in portal venous phase from the referring institutions.…”

Microenvironmental Influences on Metastasis Suppressor Expression and Function during a Metastatic Cell’s Journey

“…Biopsy of each individual metastasis is not practical, safe, nor particularly cost-effective. In recent years, there has been a resurrection of the notion to do a 'liquid biopsy,' which essentially involves sampling of circulating tumor cells (CTC) and/or cell free nucleic acids (cfDNA, including microRNA (miRNA)) present in blood and lymph [12][13][14][15][16].…”