Hugenschmidt Harald, Labori Knut Jørgen, Borgen Elin, Brunborg Cathrine, Schirmer Cecilie Bendigtsen, Seeberg Lars Thomas, Naume Bjørn, Wiedswang Gro
Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
Department of Transplantation Surgery, Oslo University Hospital, 0424 Oslo, Norway.
Cancers (Basel). 2021 Jan 27;13(3):485. doi: 10.3390/cancers13030485.
In patients with presumed pancreatic ductal adenocarcinoma (PDAC), biomarkers that may open for personalised, risk-adapted treatment are lacking. The study analysed the impact of CTCs-presence on the patterns of recurrence and survival in 98 patients resected for PDAC with 5-10 years of follow-up. Preoperative samples were analysed by the CellSearch system for EpCAM+/DAPI+/CK+/CD45-CTCs. CTCs were detected in 7 of the 98 patients. CTCs predicted a significantly shorter median disease-free survival (DFS) of 3.3 vs. 9.2 months and a median cancer specific survival (CSS)of 6.3 vs. 18.5 months. Relapse status was confirmed by imaging for 87 patients. Of these, 58 patients developed distant metastases (DM) and 29 developed isolated local recurrence (ILR) as the first sign of cancer relapse. All patients with CTCs experienced DM. pN-status and histological grade >2 were other independent risk factors for DM, but only CTCs predicted significantly shorter cancer-specific, disease-free and post-recurrence survival. Preoperative parameters did not affect clinical outcome. We conclude that CTC presence in resected PDAC patients predicted early distant metastasis and impaired survival. Preoperative CTCs alone or in combination with histopathological factors may guide initial treatment decisions in patients with resectable PDAC in the future.
在疑似胰腺导管腺癌（PDAC）患者中，缺乏可用于个性化、风险适应性治疗的生物标志物。该研究分析了循环肿瘤细胞（CTC）的存在对98例接受PDAC切除术且随访5至10年患者的复发模式和生存的影响。术前样本通过CellSearch系统分析EpCAM+/DAPI+/CK+/CD45-CTC。98例患者中有7例检测到CTC。CTC预测无病生存期（DFS）中位数显著缩短，分别为3.3个月和9.2个月，癌症特异性生存期（CSS）中位数分别为6.3个月和18.5个月。87例患者通过影像学检查确认复发状态。其中，58例患者发生远处转移（DM），29例发生孤立性局部复发（ILR）作为癌症复发的首发迹象。所有CTC阳性患者均发生DM。pN状态和组织学分级>2是DM的其他独立危险因素，但只有CTC预测癌症特异性、无病和复发后生存期显著缩短。术前参数不影响临床结局。我们得出结论，切除的PDAC患者中CTC的存在预示着早期远处转移和生存受损。术前单独使用CTC或与组织病理学因素联合使用可能在未来指导可切除PDAC患者的初始治疗决策。
