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Circulating Tumor Cells as a Biomarker for Preoperative Prognostic Staging in Patients With Esophageal Cancer

Reeh, Matthias MD*; Effenberger, Katharina E. PhD*,†; Koenig, Alexandra M. MD*; Riethdorf, Sabine PhD; Eichstädt, Dominique MD; Vettorazzi, Eik MSc; Uzunoglu, Faik G. MD*; Vashist, Yogesh K. MD*; Izbicki, Jakob R. FACS*; Pantel, Klaus PhD; Bockhorn, Maximilian MD*

doi: 10.1097/SLA.0000000000001130
Original Articles
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Objective: We evaluated the prognostic significance of circulating tumor cells (CTCs) in patients with esophageal cancer (EC).

Background: Despite the availability of several preoperative diagnostic techniques, accurate pretreatment staging of EC remains challenging.

Methods: In this single-center, prospective study, peripheral blood samples for CTC analyses were obtained preoperatively from 100 patients who were judged to have resectable EC. CTC detection was performed using the CellSearch System. Data were correlated with clinicopathological parameters and patient outcomes.

Results: CTCs were detected in 18% (18/100) of all eligible patients. Patients with CTCs showed significantly shorter relapse-free (P < 0.001) and overall survival (P < 0.001) than CTC-negative patients. Even in patients with lymph node invasion and without distant metastases (pN+, M0, N = 45), CTC detection indicated significantly worse relapse-free (P < 0.001) and overall survival (P = 0.007). Multivariate analyses of eligible patients identified CTCs as a strong, independent, prognostic indicator of tumor recurrence (hazard ratio, 5.063; 95% confidence interval, 2.233–11.480; P < 0.001) and overall survival (hazard ratio, 3.128; 95% confidence interval, 1.492–6.559; P = 0.003).

Conclusions: This is the first study to report that CTCs detected by an automated immunomagnetic detection system are independent, prognostic indicators of patients' outcome in EC. Thus, implementation of CTCs may improve accuracy of preoperative staging in EC.

We evaluated the prognostic significance of circulating tumor cells in patients with resectable esophageal cancer. In this single-center prospective study, circulating tumor cells of 100 patients were detected by using the CellSearch System. This is the first study to report that circulating tumor cells detected by an automated immunomagnetic detection system are independent, prognostic indicators of patients' outcome in esophageal cancer.

Departments of *General, Visceral, and Thoracic Surgery

Tumor Biology, and

Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.

Reprints: Matthias Reeh, MD, General, Visceral, and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail: mreeh@uke.de.

Disclosure: Supported by investigational grants from the “Hamburger Stiftung zur Foerderung der Krebsbekämpfung” and “B. Braun-Stiftung” (to M.R. and K.E.E.), and funding from The European Research Council, Brussels, (Advanced Investigator grant DISSECT, to K.P.).

The manuscript has been seen and approved by all authors.

The authors declare that the material has not been previously published or submitted for publication elsewhere.

All authors declare that they have no potential conflicts (financial, professional, or personal) to disclose that are relevant to the manuscript.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.