Circulating tumor cells are associated with poor overall... : Hepatology (original) (raw)

Hepatobiliary Malignancies

Circulating tumor cells are associated with poor overall survival in patients with cholangiocarcinoma

Yang, Ju Dong1,†; Campion, Michael B.2,†; Liu, Minetta C.2,3; Chaiteerakij, Roongruedee1,4; Giama, Nasra H.1; Ahmed Mohammed, Hager1; Zhang, Xiaodan1; Hu, Chunling1; Campion, Victoria L.1; Jen, Jin2; Venkatesh, Sudhakar K.5; Halling, Kevin C.2; Kipp, Benjamin R.2; Roberts, Lewis R.*,1

1Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterMN

2Department of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMN

3Division of Medical OncologyMayo Clinic College of MedicineRochesterMN

4Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand

5Department of RadiologyMayo Clinic College of MedicineRochesterMN

*Address reprint requests to: Lewis R. Roberts, M.B., Ch.B., Ph.D., Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905. E‐mail: [email protected]; fax: 507‐284‐0762.

†These authors contributed equally to the study.

Abstract

Circulating tumor cells (CTCs) in blood are associated with poor survival of patients with breast, prostate, or colon cancer. We hypothesized that CTCs are associated with poor survival of patients with cholangiocarcinoma (CCA). Eighty‐eight patients with CCA were prospectively enrolled at Mayo Clinic Rochester between June 2010 and September 2014. The CellSearch system by Veridex was used for detection of CTCs in peripheral blood. Associations between CTC, patient and tumor characteristics, and survival were examined using the Cox's proportional hazards model. Fifteen patients (17%) were positive for CTC ≥2 and 8 patients (9%) for CTC ≥5. CTCs were associated with tumor extent. CTC ≥2 (hazard ratio [HR]: 2.5; 95% confidence interval [CI]: 1.1‐5.4; P = 0.02) and CTC ≥5 (HR, 4.1; 95% CI: 1.4‐10.8; P = 0.01) were both independent predictors of survival. In subgroup analyses, CTC ≥2 (HR, 8.2; 95% CI: 1.8‐57.5; P < 0.01) and CTC ≥5 (HR, 7.7; 95% CI: 1.4‐42.9; P = 0.02) were both associated with shorter survival among patients with metastasis. There was a trend toward association of CTC ≥5 with shorter survival in patients with nonmetastatic CCA (HR, 4.3; 95% CI: 1.0‐13.8; P = 0.06). CTC ≥2 (HR, 10.5; 95% CI: 2.2‐40.1; P < 0.01) and CTC ≥5 (HR, 10.2; 95% CI: 1.5‐42.3; P = 0.02) were both associated with shorter survival among patients with perihilar/distal CCA. CTC ≥5 was associated with shorter survival of patients with intrahepatic CCA (HR, 4.2; 95% CI: 1.1‐14.1; P = 0.04). Conclusion: CTCs were associated with more‐aggressive tumor characteristics and independently associated with survival in patients with CCA. Assessment of CTCs may be useful for identifying CCA patients at risk of early mortality. (Hepatology 2016;63:148–158)