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Persistent Presence of Postoperative Circulating Tumor Cells is a Poor Prognostic Factor for Patients with Stage I–III Colorectal Cancer after Curative Resection

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Aim

To detect pre- and postoperative circulating tumor cells (CTCs) in stage I–III colorectal cancer (CRC) patients undergoing curative resection and so identify a subgroup of patients who are at high risk for relapse.

Methods

Four mRNA molecular markers including human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen mRNA were used to detect CTCs in 438 CRC patients underwent curative resection.

Results

Out of 438 patients, 80 CRC patients were classified to preoperative (−)/postoperative (−), 221 patients were preoperative (+)/postoperative (−), while 137 patients were preoperative (+)/postoperative (+). Univariately, postoperative relapse was significantly correlated with depth of invasion (P = 0.032), lymph node metastasis (P < 0.001), vascular invasion (P = 0.001), perineural invasion (P = 0.013), and persistent presence of CTCs (P < 0.001). Using a multivariate proportional hazards regression analysis, the presence of lymph node metastasis (P = 0.012; HR, 7.652; 95% CI: 4.162–14.827), vascular invasion (P = 0.033; HR, 4.360; 95% CI: 2.793–10.847), and the persistent presence of CTCs (P < 0.001; HR, 29.486; 95% CI: 10.281–87.792) were demonstrated to be independent predictors for postoperative relapse. Combination of these three independent predictors showed that patients with any one positive predictor had a hazard ratio of sevenfold to develop postoperative relapse (P < 0.001; HR, 7.064; 95% CI: 4.354–11.464). Furthermore, the persistent presence of CTCs was strongly correlated with poorer relapse-free survival rates (all P < 0.001).

Conclusion

The promising results of this study suggest that persistent presence of postoperative CTCs may be a crucial prognostic factor adjuvant to conventional tumor markers in CRC patients who have undergone curative resection. Identification of these high-risk patients of persistent CTCs positivity is important and thus could help to define patients for adjuvant therapy with this tumor entity.

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Acknowledgements

The authors would like to thank Drs. Jan-Sing Hsieh, Deng-Chyang Wu, Yu-Chung Su, Jeng-Yih Wu, and Che-Jen Huang for contributing materially to the paper. This study was supported by a grant from the Chi Mei Medical Center and Kaohsiung Medical University Research Foundation (97CM-KMU-03).

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Chi Mei Foundation Medical Center, Taipei Medical University, Taipei, Taiwan

    Yih-Huei Uen MD

  2. Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chien-Yu Lu MD & Fang-Jung Yu MD

  3. Department of Emergency Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai MD

  4. Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan

    Hsiang-Lin Tsai MD & Jaw-Yuan Wang MD, PhD

  5. Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ming-Yii Huang MD

  6. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ming-Yii Huang MD & Jaw-Yuan Wang MD, PhD

  7. Faculty of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan

    Tian-Lu Cheng PhD

  8. Department of Medical Research, Fooyin University Hospital, Kaohsiung, Taiwan

    Shiu-Ru Lin PhD

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  1. Yih-Huei Uen MD
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  2. Chien-Yu Lu MD
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Corresponding authors

Correspondence to Shiu-Ru Lin PhD or Jaw-Yuan Wang MD, PhD.

Additional information

Shiu-Ru Lin and Jaw-Yuan Wang contributed equally to this paper.

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Uen, YH., Lu, CY., Tsai, HL. et al. Persistent Presence of Postoperative Circulating Tumor Cells is a Poor Prognostic Factor for Patients with Stage I–III Colorectal Cancer after Curative Resection. Ann Surg Oncol 15, 2120–2128 (2008). https://doi.org/10.1245/s10434-008-9961-7

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  • DOI: https://doi.org/10.1245/s10434-008-9961-7

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