Intraoperative detection of circulating tumor cells in pulmonary venous blood during metastasectomy for colorectal lung metastases

Uyen-Thao Le, Peter Bronsert, Francesco Picardo, Sabine Riethdorf, Benedikt Haager, Bartosz Rylski, Martin Czerny, Friedhelm Beyersdorf, Sebastian Wiesemann, Klaus Pantel, Bernward Passlick, Jussuf Thomas Kaifi (+1 others)
2018 Scientific Reports  
Circulating tumor cells (CTC) have been studied extensively in various tumor types and are a wellestablished prognosticator in colorectal cancer (CRC) . This is the first study to isolate CTC directly from the tumor outflow in secondary lung tumors. For this purpose in 24 patients with CRC who underwent pulmonary metastasectomy in curative intent blood was drawn intraoperatively from the pulmonary vein (tumor outflow). In 22 samples CTC-enumeration was performed using CellSieve-microfilters and
more » ... immunohistochemical-and Giemsa-staining. Additionally 10 blood samples were analyzed using the CellSearch-System. We could isolate more CTC in pulmonary venous blood (total 41, range 0-15) than in samples taken from the periphery at the same time (total 6, range 0-5, p = 0.09). Tumor positive lymph nodes correlated with presence of CTC in pulmonary venous blood as in all cases CTC were present (p = 0.02). Our findings suggest a tumor cell release from pulmonary metastases in CRC and a correlation of CTC isolated from the tumor outflow with established negative prognostic markers in metastasized CRC. The presented data warrant further investigations regarding the significance of local tumor compartments when analyzing circulating markers and the possibility of tumor cell shedding from secondary lung tumors. During the course of disease up to one half of patients with colorectal cancer (CRC) develop metastasis with a predilection for the liver and lung 1 . Prognosis in metastasized CRC is often unfavorable, however pulmonary metastasectomy in selected patients is associated with a considerable prognosis with 5-year survival rates between 40 and 70% and sometimes even results in cure 2-4 . The decision making for treatment modalities is a multidisciplinary challenge and application of local measures to a systemic disease remains controversial and is thought to only be beneficial if there is no dissemination of tumor cells and metastases. Consequently a good selection of patients for surgical therapy is crucial. Current criteria are based solely on clinical observations such as the disease-free interval, tumor burden and general dynamics which are surrogate parameters for a favorable tumor biology 5-7 .
doi:10.1038/s41598-018-26410-8 pmid:29884810 pmcid:PMC5993733 fatcat:w3ig5imfyvghfclfjfm3gbbppe