Unique Localization of Circulating Tumor Cells in Patients With Hepatic Metastases

Abstract

A B S T R A C T PurposeThere are few data on the impact of immediate and differing surgical interventions on circulating tumor cells (CTCs), nor their compartmentalization or localization in different anatomic vascular sites. Patients and MethodsCTCs from consecutive patients with colorectal liver metastases were quantified before and immediately after open surgery, laparoscopic resection, open radiofrequency ablation (RFA), or percutaneous RFA. For individuals undergoing open surgery, either hepatic resections or open RFA, CTCs were examined in both systemic and portal circulation by measuring CTCs in samples derived from the peripheral vein, an artery, the hepatic portal vein, and the hepatic vein. ResultsA total of 29 consecutive patients with colorectal liver metastases with a median age of 55 years (range, 30 to 88 years) were included. CTCs were localized to the hepatic portosystemic macrocirculation with significantly greater numbers than in the systemic vasculature. Surgical procedures led to a statistically significant fall in CTCs at multiple sites measured. Conversely, RFA, either open or percutaneous, was associated with a significant increase in CTCs. ConclusionSurgical resection of metastases, but not RFA, immediately decreases CTC levels. In patients with colorectal liver metastases, CTCs appear localized to the hepatic (and pulmonary) macrocirculations. This may explain why metastases in sites other than the liver and lungs are infrequently observed in cancer.

Capture of Viable Circulating Tumor Cells in the Liver of Colorectal Cancer Patients

“…The present results showed a significant mesentericoperipheral gradient of CTCs and therefore support the view that the liver is a filter for CTCs (12,15 ). Using 2 independent assays, we detected significantly more CTCs in the mesenteric blood compared with the peripheral blood.…”

Portal-vein blood samples as a new diagnostic entity for pancreatic cancer

“…Thus, it is conceivable that ctDNA and CTCs are likely to be more abundant in the portal venous circulation prior to being sequestered in the liver. In line with this hypothesis was the finding that CTCs in portal venous blood were significantly higher compared to peripheral blood (median 87 CTCs per 7.5 mL vs. 1 CTC per 7.5 mL) acquired intraoperatively in patients with colorectal liver metastases [14].…”

Circulating Tumor Cells from Different Vascular Sites Exhibit Spatial Heterogeneity in Epithelial and Mesenchymal Composition and Distinct Clinical Significance in Hepatocellular Carcinoma

“…Consequently, these findings offer a new avenue for understanding human tumor metastasis by interrogating CTCs from multiple vascular sites. Recent studies compared CTC counts among multiple vascular compartments in breast cancer and colorectal cancer, but the clinical relevance of CTC anatomic distribution patterns in HCC still remains unclear (21,31). In this study, we prospectively measured CTCs at five key vascular sites in patients with localized HCC.…”