Endoscopic ultrasound acquired portal venous circulating tumor cells predict progression free survival and overall survival in patients with pancreaticobiliary cancers

Chapman, Christopher G.; Ayoub, Fares; Swei, Eric; Llano, Ernesto M.; Li, Betty; Siddiqui, Uzma D.; Waxman, Irving

doi:10.1016/j.pan.2020.10.039

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Furthermore, the mean count of CTCs in the portal venous blood was approximately 10 times higher than that in the peripheral blood (282.0/7.5 mL vs 21.0/7.5 mL, P < 0.01). Similar results were reported by Chapman et al [ 30 ]; portal venous blood demonstrated superior outcomes in both the detection rate (100% vs 23.5%) and enumeration (mean count, 118/7.5 mL vs 0.67/7.5 mL) in 17 patients with pancreaticobiliary cancers. Zhang et al [ 31 ] and Choi et al [ 32 ] reported that the number of CTCs in the portal venous blood was higher than that in the peripheral blood, whereas the detection rates were comparable between the portal and peripheral blood.…”

Section: Clinical Utility Of Portal Venous Ctcssupporting

confidence: 89%

“…According to a study by Liu et al [ 23 ] which included 29 patients with locally advanced or metastatic PC, OS was significantly shorter in patients with a CTC count ≥ 150/7.5 mL in portal venous blood compared to those with a CTC count ≤ 150/7.5 mL (median OS 9.2 wk vs 19.8 wk, P < 0.01). A similar result was reported by Chapman et al [ 30 ]; specifically, patients with portal venous CTCs ≥ 185/7.5 mL had significantly shorter PFS than patients with CTCs < 185/7.5 mL (mean PFS, 12.8 wk vs 43.3 wk, P < 0.01). OS was also unfavorable in patients with higher counts of CTCs; however, the difference was not significant (mean OS, 29.5 wk vs 75.4 wk, P = 0.07).…”

Section: Clinical Utility Of Portal Venous Ctcssupporting

confidence: 88%

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Clinical implications and perspectives of portal venous circulating tumor cells in pancreatic cancer

Ko¹,

Yoon²

2023

World J Gastrointest Oncol

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Despite recent improvements in the diagnosis and treatment of pancreatic cancer (PC), clinical outcomes remain dismal. Moreover, there are no effective prognostic or predictive biomarkers or options beyond carbohydrate antigen 19-9 for personalized and precise treatment. Circulating tumor cells (CTCs), as a member of the liquid biopsy family, could be a promising biomarker; however, the rarity of CTCs in peripheral venous blood limits their clinical use. Because the first venous drainage of PC is portal circulation, the portal vein can be a more suitable location for the detection of CTCs. Endoscopic ultrasound-guided portal venous sampling of CTCs is both feasible and safe. Several studies have suggested that the detection rate and number of CTCs may be higher in the portal blood than in the peripheral blood. CTC counts in the portal blood are highly associated with hepatic metastasis, recurrence after surgery, and survival. The phenotypic and genotypic properties measured in the captured portal CTCs can help us to understand tumor heterogeneity and predict the prognosis of PC. Small sample sizes and heterogeneous CTC detection methods limit the studies to date. Therefore, a large number of prospective studies are needed to corroborate portal CTCs as a valid biomarker in PC.

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Section: Clinical Utility Of Portal Venous Ctcssupporting

confidence: 89%

Section: Clinical Utility Of Portal Venous Ctcssupporting

confidence: 88%

Clinical implications and perspectives of portal venous circulating tumor cells in pancreatic cancer

Ko¹,

Yoon²

2023

World J Gastrointest Oncol

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“…These results support the conclusion of previous studies that patients with a high number of CTCs in PoV may have an adverse prognosis and may require efficient managements to improve clinical outcomes. 24,33,35 In conclusion, we provided a systematic approach in detecting PoV CTCs for PC diagnosis and prognosis prediction. Acquisition of the PoV samples in patients with PC via EUS-guided procedures has been proved to be safe and feasible.…”

Section: Data Sharing Statementmentioning

confidence: 90%

“…Due to the challenging nature of the procedure, there are no other studies reporting EUS acquired PoV sampling. 24 PC remains one of the deadliest cancers with poor prognosis due to lack of specific symptoms and early biomarkers for this highly aggressive disease. 25 In parallel with the search for new strategies to treatment, the most significant challenge is to discover novel biomarkers to ensure early detection, predict prognosis, and help risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Acquisition of Portal Venous Circulating Tumor Cells as a Potential Diagnostic and Prognostic Tool for Pancreatic Cancer

Zhang¹,

Su²,

Wang³

et al. 2021

CMAR

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Background: Circulating tumor cells (CTCs) were a promising liquid biopsy for pancreatic cancer (PC) but circulate in low counts in peripheral blood. We evaluated the diagnostic and prognostic values of portal vein (PoV) CTCs in PC patients. Methods: PoV was aspirated under EUS guidance from 40 patients with suspected pancreaticobiliary cancers. Epithelial-mesenchymal-transition-related subtypes of CTCs were identified via immunofluorescence using EpCAM and Twist antibodies. The diagnostic and prognostic performance of PoV CTCs was investigated by receiver-operating characteristic (AUC) curve and Kaplan-Meier survival analysis. Results: In total, 40 patients including 31 with PC, 4 with non-pancreatic periampullary cancer and 5 with benign pancreatic diseases (BPD) were enrolled. CTCs were detected more in PoV compared with peripheral blood. PoV CTC numbers in BPD patients were lower than in PC patients. The number of PoV CTCs, especially mesenchymal-CTCs (M-CTCs), was positively correlated with the tumor burden, instead of epithelial-CTCs (E-CTCs). The combination of PoV CTC numbers and CA19-9 demonstrated better diagnostic efficiency (AUC value 0.987) than either alone in differentiating PC with BPD. Moreover, the diagnostic efficacy of PoV CTCs and M-CTCs were obviously better than that of E-CTCs and CA19-9 in distinguishing early and late stage PC. Lastly, high PoV CTC and M-CTC numbers were both associated with shorter overall survival. Conclusion: Acquisition of the PoV samples in PC patients via EUS-guided procedures has been proved safe and feasible. PoV CTCs, especially M-CTCs, have great potentials in diagnosing and predicting the prognosis of PC, especially in combination with CA19-9.

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“…portal venous as the main drain tube of pancreas with abundant CTCs and the promising clinical application value of portal venous CTCs test had been demonstrated by previous studies (4,7,9,37). Recently, ultrasound-guided ( 9) and endoscopic ultrasound-guided (39,40) fine-needle aspiration have gradually been used to obtain portal venous blood in advanced PDAC patients. However, portal vein puncture is an invasive approach with the possibility of bleeding、 infection、thrombotic、tumor cell spread.…”

Section: Discussionmentioning

confidence: 99%

Portal Venous Circulating Tumor Cells Undergoing Epithelial-Mesenchymal Transition Exhibit Distinct Clinical Significance in Pancreatic Ductal Adenocarcinoma

Pan

Yang

et al. 2021

Front. Oncol.

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BackgroundMuch importance is attached to the clinical application value of circulating tumor cells (CTCs), meanwhile tumor-proximal CTCs detection has interested researchers for its unique advantage. This research mainly discusses the correlation of portal venous (PoV) CTCs counts in different epithelial-mesenchymal transition status with clinicopathologic parameters and postoperative prognosis in resectable pancreatic ductal adenocarcinoma patients (PDAC).MethodsPDAC patients (n=60) who received radical resection were enrolled in this research. PoV samples from all patients and peripheral venous (PV) samples from 32 patients among them were collected to verify spatial heterogeneity of CTCs distribution, and explore their correlation with clinicopathologic parameters and clinical prognosis.ResultsCTCs detectable rate and each phenotype count of PoV were higher than those of PV. Patients with recurrence had higher PV and PoV epithelial CTCs (E-CTCs) counts than recurrence-free patients (P<0.05). Some unfavourable clinicopathologic parameters were closely related to higher PoV CTCs counts. Multivariate regression analysis demonstrated that PoV mesenchymal CTC (M-CTC)s≥1/5 ml was an independent risk factor for metastasis free survival (MFS) (P=0.003) and overall survival (OS) (P=0.043).ConclusionsOur research demonstrated that portal venous was a preferable vessel for CTC test, and patients with PoV M-CTC≥1/5 ml had shorter MFS and OS time in resectable PDAC patients. PoV CTC phenotype detection has the potential to be a reliable and accurate tool to identify resectable PDAC patients with high tendency of postoperative metastasis for better stratified management.

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Endoscopic ultrasound acquired portal venous circulating tumor cells predict progression free survival and overall survival in patients with pancreaticobiliary cancers

Cited by 8 publications

References 21 publications

Clinical implications and perspectives of portal venous circulating tumor cells in pancreatic cancer

Clinical implications and perspectives of portal venous circulating tumor cells in pancreatic cancer

Endoscopic Ultrasound-Guided Acquisition of Portal Venous Circulating Tumor Cells as a Potential Diagnostic and Prognostic Tool for Pancreatic Cancer

Portal Venous Circulating Tumor Cells Undergoing Epithelial-Mesenchymal Transition Exhibit Distinct Clinical Significance in Pancreatic Ductal Adenocarcinoma

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