Connor Ashton A, McNamara Kate, Al-Sukhni Eisar, Diskin Jacob, Chan David, Ash Colleen, Lowes Lori E, Allan Alison L, Zogopoulos George, Moulton Carol-Anne, Gallinger Steven
Hepatobiliary/Pancreatic Surgical Oncology Program, University Health Network, Toronto, ON, Canada.
The Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
Ann Surg Oncol. 2016 Jul;23(7):2168-75. doi: 10.1245/s10434-015-5038-6. Epub 2015 Dec 29.
Colorectal cancer liver metastases (CRLMs) are potentially curable with resection, but most patients recur and succumb to their disease. Clinical covariates do not account for all outcomes. Circulating tumor cells (CTCs) are prognostic in the primary and metastatic settings of breast, prostate and colorectal cancer (CRC), and evolving evidence supports their role in CRLMs. Our objective was to determine whether CTCs in peripheral (PV) and hepatic venous (HV) compartments are associated with disease-free survival (DFS) and overall survival (OS) post-CRLM resection.
CTCs were measured by CellSearch assay from intraoperative HV and PV samples from 63 patients who underwent CRLM resection from June 2007 to August 2012 at a single center. DFS and OS were primary endpoints.
HV CTCs > 3 were associated with shorter DFS and OS, but not PV CTCs, although no significant difference was found between CTC measurements in the two compartments. By univariate analysis, CRC stage and site, CRLM recurrence, and hepatic capsule invasion were also associated with OS, but only HV CTCs and CRC site were significant by multivariate Cox. Only HV CTCs were associated with DFS by multivariate analysis. Cases with elevated HV CTCs had hepatic vein invasion and lymph node metastases, and were younger with larger tumors.
Elevated HV CTCs are prognostic for DFS and OS following CRLM resection. Clinicopathologic features associated with HV CTCs are identifiable preoperatively and should be considered in CRLM surgical decision making. We found no evidence that PV CTCs are prognostic in this setting.
结直肠癌肝转移（CRLMs）有可能通过手术切除治愈，但大多数患者会复发并死于该疾病。临床协变量并不能解释所有的预后情况。循环肿瘤细胞（CTCs）在乳腺癌、前列腺癌和结直肠癌（CRC）的原发和转移情况下具有预后价值，且越来越多的证据支持其在CRLMs中的作用。我们的目的是确定外周血（PV）和肝静脉（HV）中的CTCs是否与CRLM切除术后的无病生存期（DFS）和总生存期（OS）相关。
对2007年6月至2012年8月在单一中心接受CRLM切除的63例患者术中获取的HV和PV样本，采用CellSearch检测法测量CTCs。DFS和OS为主要终点。
HV中CTCs>3与较短的DFS和OS相关，但PV中的CTCs则不然，尽管两个腔室的CTCs测量值之间未发现显著差异。单因素分析显示，CRC分期和部位、CRLM复发以及肝包膜侵犯也与OS相关，但多因素Cox分析显示只有HV CTCs和CRC部位具有显著性。多因素分析显示只有HV CTCs与DFS相关。HV CTCs升高的病例存在肝静脉侵犯和淋巴结转移，且患者较年轻，肿瘤较大。
CRLM切除术后，升高的HV CTCs对DFS和OS具有预后价值。与HV CTCs相关的临床病理特征在术前即可识别，在CRLM手术决策中应予以考虑。我们没有发现证据表明PV CTCs在这种情况下具有预后价值。
