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- Matthias Reeh, Katharina E Effenberger, Alexandra M Koenig, Sabine Riethdorf, Dominique Eichstädt, Eik Vettorazzi, Faik G Uzunoglu, Yogesh K Vashist, Jakob R Izbicki, Klaus Pantel, and Maximilian Bockhorn.
- Departments of *General, Visceral, and Thoracic Surgery †Tumor Biology, and ‡Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.
- Ann. Surg. 2015 Jun 1; 261 (6): 1124-30.
ObjectiveWe evaluated the prognostic significance of circulating tumor cells (CTCs) in patients with esophageal cancer (EC).BackgroundDespite the availability of several preoperative diagnostic techniques, accurate pretreatment staging of EC remains challenging.MethodsIn 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.ResultsCTCs 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).ConclusionsThis 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.
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