Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Clin Transl Gastroenterol. 2019 Jul;10(7):e00055. doi: 10.14309/ctg.0000000000000055.
Circulating tumor cells (CTCs) in the blood have been used as diagnostic markers in patients with colorectal cancer (CRC). In this study, we evaluated a CTC detection system based on cell size to assess CTCs and their potential as early diagnostic and prognostic biomarkers for CRC.
From 2014 to 2015, 88 patients with newly diagnosed CRC, who were scheduled for surgery, and 31 healthy volunteers were enrolled and followed up in Pusan National University Hospital. CTCs were enriched using a centrifugal microfluidic system with a new fluid-assisted separation technique (FAST) and detected by cytomorphological evaluation using fluorescence microscopy.
Two or more CTCs were detected using FAST in 74 patients and 3 healthy volunteers. The number of CTCs in the CRC group was significantly higher than that in the healthy volunteers (P < 0.001). When a receiver operating characteristic curve was created to differentiate patients with CRC from healthy volunteers, the sensitivity and specificity were almost optimized when the critical CTC value was 5/7.5 mL of blood. When this value was used, the sensitivity and specificity in differentiating patients with CRC from the healthy controls were 75% and 100%, respectively. In patients with CRC with ≥5 CTCs, vascular invasion was frequently identified (P = 0.035). All patients with stage IV were positive for CTCs. Patients with ≥5 CTCs showed a trend toward poor overall and progression-free survival.
Our study demonstrated promising results with the use of FAST-based CTC detection for the early diagnosis and prognosis of CRC.
血液中的循环肿瘤细胞（CTC）已被用作结直肠癌（CRC）患者的诊断标志物。在本研究中，我们评估了一种基于细胞大小的 CTC 检测系统，以评估 CTC 及其作为 CRC 早期诊断和预后生物标志物的潜力。
2014 年至 2015 年，88 例新诊断为 CRC 并计划手术的患者和 31 名健康志愿者在釜山国立大学医院接受了入组和随访。使用带有新液力辅助分离技术（FAST）的离心微流控系统富集 CTC，并通过荧光显微镜进行细胞形态学评估来检测 CTC。
使用 FAST 在 74 例患者和 3 例健康志愿者中检测到 2 个或更多 CTC。CRC 组的 CTC 数量明显高于健康志愿者（P<0.001）。当创建区分 CRC 患者和健康志愿者的受试者工作特征曲线时，当临界 CTC 值为 5/7.5mL 血液时，灵敏度和特异性几乎达到最佳。当使用该值时，区分 CRC 患者和健康对照组的灵敏度和特异性分别为 75%和 100%。在 CTC≥5 的 CRC 患者中，常发现血管侵犯（P=0.035）。所有 IV 期患者的 CTC 均为阳性。CTC≥5 的患者总生存期和无进展生存期均有较差的趋势。
我们的研究结果表明，使用基于 FAST 的 CTC 检测在 CRC 的早期诊断和预后方面具有广阔的前景。
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