Prognostic value of circulating endothelial cells in metastatic colorectal cancer
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Nuh N. Rahbari1,*, Sebastian Schölch1,*, Ulrich Bork1, Christoph Kahlert1, Martin Schneider2, Mohammad Rahbari1, Markus W. Büchler2, Jürgen Weitz1 and Christoph Reissfelder1
1Department of Gastrointestinal, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
2Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
*These authors have contributed equally to this work
Nuh N. Rahbari, email: [email protected]
Keywords: circulating endothelial cells, CEC, circulating tumor cells, CTC, colorectal cancer
Received: October 04, 2016 Accepted: March 01, 2017 Published: March 21, 2017
BACKGROUND: There is urgent need for improved staging in patients with metastatic colorectal cancer (mCRC). In this study, we evaluated the prognostic value of circulating endothelial cells (CEC) in comparison with circulating tumor cells (CTC) in patients with mCRC amenable for potentially curative surgery.
METHODS: A total of 140 patients were enrolled prospectively. CTC and CEC were measured with the CellSearch System (Veridex, NJ, USA). Cut-off values were determined using ROC analyses. Prognostic factors were identified by Cox proportional hazards models.
RESULTS: ROC analyses revealed ≥ 21 CEC as cut-off levels for detection, which was present in 68 (49%). CEC detection was associated with female gender (p = 0.03) only, whereas CTC detection was associated with presence of the primary tumor (p = 0.007), metastasis size (p < 0.001), bilobar liver metastases (p = 0.02), CEA (p < 0.001) and CA 19-9 levels (p < 0.001). On multivariate analysis only CEC detection (HR 1.81; p = 0.03) and preoperative CA19-9 levels (HR 2.28, p = 0.005) were revealed as independent predictors of poor survival.
CONCLUSIONS: CEC are of stronger prognostic value than CTC. Further studies are required to validate these results and to evaluate CEC as predictive biomarker for systemic therapy alone as well as in combination with other markers such as CA19-9.
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