BACKGROUND The authors hypothesized that circulating tumor cells (CTCs) in patients with gastric cancer are associated with prognosis and disease recurrence. In this study, they evaluated CTCs in gastric cancer and clarified the clinical impact of CTCs. METHODS In total, 265 consecutive patients with gastric cancer were enrolled. Fourteen patients were excluded from the analysis, including 12 patients who another cancer and 2 patients who refused the treatment. The remaining 251 patients were divided into 2 groups: 148 patients who underwent gastrectomy (the resection group) and 103 patients who did not undergo gastrectomy (the nonresectable group). Peripheral blood samples were collected before gastrectomy or chemotherapy. A proprietary test for capturing, identifying, and counting CTCs in blood was used for the isolation and enumeration of CTCs. RESULTS CTCs were detected in 16 patients (10.8%) from the resection group and in 62 patients (60.2%) from the nonresectable group. The overall survival rate for the entire cohort was significantly lower in patients with CTCs than in those without CTCs (P < .0001). In the resection group, relapse‐free and overall survival in patients with CTCs was significantly lower than in patients without CTCs (P < .0001). It was noteworthy that the expression of CTCs was an independent factor for determining the overall survival of patients with gastric cancer in multivariate analysis (P = .024). In the nonresectable group, the overall survival rate was significantly lower in patients with CTCs than in those without CTCs (P = .0044). CONCLUSIONS The evaluation of CTCs in peripheral blood may be a useful tool for predicting tumor progression, prognosis, and the effect of chemotherapy in patients with gastric cancer. Cancer 2013;119:3984–3991. © 2013 American Cancer Society.

BackgroundEsophageal squamous cell carcinoma is an aggressive gastrointestinal tract cancer. To date, the presence of circulating tumor cells (CTC) has been reported as a prognostic factor in peripheral blood from patients with gastrointestinal cancers.MethodsThe CellSearch system was used to isolate and enumerate CTCs. A total of 90 patients with esophageal squamous cell carcinoma who received chemotherapy or chemoradiotherapy were enrolled. Peripheral blood specimens were collected before and after treatments.ResultsAt baseline analysis, CTCs were detected in 25 patients (27.8 %). Overall survival was significantly shorter in patients with than without CTCs. Follow-up blood specimens were obtained from 71 patients. Partial response, stable disease, and progressive disease after treatment were seen in 32, 12, and 27 patients, respectively. CTC positivity after treatment in the progressive disease group (40.7 %) was significantly higher than that of the partial response group (6.3 %). Patients with a change in CTC status from positive to negative had a good prognosis as well as patients without baseline CTCs.ConclusionsEvaluation of CTCs may be a promising indicator for predicting tumor prognosis and the clinical efficacy of chemotherapy or chemoradiation therapy in patients with esophageal squamous cell carcinoma.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-015-4392-8) contains supplementary material, which is available to authorized users.

The B7-H4 coregulatory molecule is a novel prognostic marker related to the T-cell-mediated immune response, and its pathway may be a molecular target for controlling tumor progression in patients with gastric cancer.

Stanniocalcin 2 (STC2) is a glycoprotein hormone that plays an important role in calcium and phosphate homeostasis. Furthermore, recent studies have demonstrated that STC2 expression in the primary site is correlated with tumor progression in several types of malignancies. However, few reports have investigated the clinical significance of STC2 expression in the blood of patients with gastric cancer. Therefore, we examined STC2 expression as a molecular blood marker for detection of circulating tumor cells (CTCs) and assessed the relationship between STC2 expression and clinico-pathological features including prognosis in patients with gastric cancer. Quantitative PCR assay was used to assess STC2 mRNA expression in 4 gastric cancer cell lines and in blood specimens from 93 patients with gastric cancer and 22 healthy volunteers. The numbers of STC2 mRNA copies were significantly higher in the gastric cancer cell lines and in blood from patients with gastric cancer than in blood from healthy volunteers (P=0.0002 and P=0.01, respectively). STC2 expression was positive in 43 (46.2%) of the 93 patients with gastric cancer, and its expression was significantly correlated with age, depth of tumor invasion, lymph node metastasis, stage and venous invasion (P=0.023, P=0.045, P=0.035, P=0.007 and P=0.027, respectively). The 5-year survival rate was significantly lower in patients with STC2 expression compared to patients without STC2 expression (P=0.014). Our results indicate that STC2 could be a useful molecular blood marker for predicting tumor progression by monitoring CTCs in patients with gastric cancer.

Objective: We investigated stanniocalcin 1 (STC 1) expression to assess its clinical utility as a blood marker in patients with gastric cancer and evaluated its biological impact in terms of tumor aggressiveness. Methods: Blood specimens from 93 patients with gastric cancer and 21 normal healthy volunteers were assessed by quantitative reverse transcription-polymerase chain reaction for STC 1 mRNA expression. Results: The relative numbers of STC 1 mRNA copies were significantly higher in gastric cancer cell lines and in blood specimens from patients with gastric cancer than in blood specimens from healthy volunteers (p = 0.0001 and p = 0.003, respectively). The sensitivity and specificity of STC 1 mRNA expression for discriminating patients with gastric cancer from healthy volunteers were 69.9 and 71.4%, respectively. Furthermore, the sensitivity for STC 1 mRNA was higher than that for serum carcinoembryonic antigen and carbohydrate antigen 19-9. The presence of STC 1 expression was significantly correlated with depth of tumor invasion and tumor stage (p = 0.032 and p = 0.013, respectively). Conclusion: Our data strongly suggest that STC 1 is a potentially useful blood marker for predicting biological tumor aggressiveness in patients with gastric cancer.