Circulating Tumor Cells Predict Occult Metastatic Disease and Prognosis in Pancreatic Cancer

Colin M. Court, Jacob S. Ankeny, Shonan Sho, Paul Winograd, Shuang Hou, Min Song, Zev A. Wainberg, Mark D. Girgis, Thomas G. Graeber, Vatche G. Agopian, Hsian Rong Tseng, James S. Tomlinson

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Background: Occult metastatic tumors, below imaging thresholds, are a limitation of staging systems that rely on cross-sectional imaging alone and are a cause of the routine understaging of pancreatic ductal adenocarcinomas (PDACs). We investigated circulating tumor cells (CTCs) as a preoperative predictor of occult metastatic disease and as a prognostic biomarker for PDAC patients. Experimental Design: A total of 126 patients (100 with cancer, 26 with benign disease) were enrolled in our study and CTCs were identified and enumerated from 4 mL of venous blood using the microfluidic NanoVelcro assay. CTC enumeration was correlated with clinicopathologic variables and outcomes following both surgical and systemic therapies. Results: CTCs were identified in 78% of PDAC patients and CTC counts correlated with increasing stage (ρ = 0.42, p OpenSPiltSPi 0.001). Of the 53 patients taken for potentially curative surgery, 13 (24.5%) had occult metastatic disease intraoperatively. Patients with occult disease had significantly more CTCs than patients with local disease only (median 7 vs. 1 CTC, p OpenSPiltSPi 0.0001). At a cut-off of three or more CTCs/4 mL, CTCs correctly identified patients with occult metastatic disease preoperatively (area under the receiver operating characteristic curve 0.82, 95% confidence interval (CI) 0.76–0.98, p OpenSPiltSPi 0.0001). CTCs were a univariate predictor of recurrence-free survival following surgery [hazard ratio (HR) 2.36, 95% CI 1.17–4.78, p = 0.017], as well as an independent predictor of overall survival on multivariate analysis (HR 1.38, 95% CI 1.01–1.88, p = 0.040). Conclusions: CTCs show promise as a prognostic biomarker for PDAC patients at all stages of disease being treated both medically and surgically. Furthermore, CTCs demonstrate potential as a preoperative biomarker for identifying patients at high risk of occult metastatic disease.

Original languageEnglish (US)
Pages (from-to)1000-1008
Number of pages9
JournalAnnals of Surgical Oncology
Issue number4
StatePublished - Apr 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology


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