Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
Curr Treat Options Oncol. 2010 Jun;11(1-2):1-13. doi: 10.1007/s11864-010-0115-3.
Recent advances in immunomagnetic separation and flow cytometry have made the detection and characterization of circulating tumor cells (CTC) a reality. This technology has already demonstrated prognostic significance in breast and prostate cancer. In the current review, we will review the historical and current data regarding the enumeration and identification of CTC in colorectal cancer. With immunomagnetic separation techniques, CTC can reliably and reproducibly be identified within 1 to 2 cells in a 7.5 mL sample of peripheral blood. Prospective studies have demonstrated a significant adverse impact on survival with the presence of > or = 3 CTC per 7.5 mL blood. Approximately one quarter of patients with metastatic disease will be categorized in this poor prognosis group. In addition, change in number of cells on treatment has prognostic significance. While CTC enumerated through immunomagnetic separation are a clear prognostic factor for patients with mCRC, the future challenge is to study whether treatment decision-making should be impacted by their level. Low cell yield in mCRC is a potential hinderance to answering these important clinical questions at present. CTC can also be isolated and studied with flow cytometry, FISH, and RT-PCR, allowing real-time assessment of tumor biology. Future advances in this field will improve both the detection and manipulation of these cells. Improvements in detection and characterization of CTC will hopefully lead to refinement of the surgical and chemotherapeutic treatment of colorectal cancer.
免疫磁珠分离和流式细胞术的最新进展使循环肿瘤细胞（CTC）的检测和鉴定成为现实。这项技术在乳腺癌和前列腺癌中已经显示出了预后意义。在当前的综述中，我们将回顾关于结直肠癌中 CTC 的计数和鉴定的历史和当前数据。通过免疫磁珠分离技术，可以在 7.5 毫升外周血样本中可靠且可重复地鉴定出 1 至 2 个 CTC。前瞻性研究表明，存在>或= 3 个 CTC/7.5 毫升血液与生存的显著不利影响相关。大约四分之一的转移性疾病患者将被归入这个预后不良的组。此外，细胞数量的变化在治疗上具有预后意义。虽然通过免疫磁珠分离计数的 CTC 是 mCRC 患者的明确预后因素，但未来的挑战是研究是否应该根据它们的水平来影响治疗决策。mCRC 中的细胞产量低是目前回答这些重要临床问题的一个潜在障碍。CTC 也可以用流式细胞术、FISH 和 RT-PCR 进行分离和研究，从而实时评估肿瘤生物学。该领域的未来进展将提高这些细胞的检测和操作能力。CTC 的检测和鉴定的改进有望使结直肠癌的手术和化疗治疗得到改善。
