The effect of circulating tumor cells on the survival of patients with pancreatic cancer − 5-year results

Authors: L. Bébarová 1;  P. Skalický 1;  J. Srovnal 2;  A. Prokopová 2;  J. Zapletalová 3;  M. Hajdůch 2;  M. Loveček 1
Authors‘ workplace: I. chirurgická klinika LF Univerzity Palackého a FN Olomouc 1;  Ústav molekulární a translační medicíny LF Univerzity Palackého a FN Olomouc 2;  Ústav lékařské biofyziky LF Univerzity Palackého a FN Olomouc 3
Published in: Rozhl. Chir., 2018, roč. 97, č. 2, s. 94-98.
Category: Original articles


Pancreatic cancer (PDAC) is one of the most aggressive malignancies. Its incidence increases worldwide and, despite the developments in cancer research, mortality rates have not decreased. Poor prognosis of the disease is due to many factors, mainly late diagnosis. Distant metastases and peritoneal carcinomatosis are caused by hematogenous and lymphogenous spreading of the tumorous cells. One of the factors that may influence patient survival are so-called circulating tumor cells (CTCs). The aim of our work was to evaluate the possible influence of CTCs on the survival of patients with PDAC.

We included patients who underwent a radical or palliative surgical intervention at the First Department of Surgery of Medical Faculty and University Hospital in Olomouc between 1 January 2008 and 31 December 2012. The required samples for CTCs detection were taken from each patient. The detection of the CTCs was performed using real-time RT-PCR. The results were statistically processed and evaluated.

We included 126 patients in total, of which 88 were treated radically and 38 received palliative treatment. Mean age was 63 years in patients with radical and 64 years in patients with palliative surgery. Mean survival time in radically treated patients was 29.6 months, in patients with palliative treatment the mean survival time was 8.5 months. The survival time of radically treated patients with CTCs was 27.2 months, without CTCs it was 33.8 months.

We did not prove a statistically significant difference in survival between radically treated PDAC patients with and without detected CTCs in our work.

Key words:
pancreatic cancer – circulating tumor cells − survival


1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe. Estimates for 40 countries in 2012. European Journal of Cancer 2013;49:1374−1403.

2. Bachmann J, Michalski ChW, Martignoni ME, et al. Pancreatic resection for pancreatic cancer. HPB (Oxford) 2006;8:346–51.

3. Neoptolemos JP, Urrutia R, Abbruzzese JL, et al. Pancreatic cancer. Springer Science+Business Media LLC 2010. Available from: DOI 10.1007/978-0-387-77498-5.

4. Ducreux M, Cuhna A, Caramella C, et al. Cancer of the pankreas: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2015;26:56−68.

5. Klos D, Lovecek M, Srovnal J, et al. Possibility of using the determination of minimal residual disease in pancreatic adenocarcinoma using real-time RT-PCR – a pilot study. Cas Lek Cesk 2010;149:69−73.

6. Berger HG, Rau B, Gansauge F, et al. Pancreatic cancer – low survival rates. Dtsch Arztebl Int 2008;105:255–62.

7. Lovecek M, Skalicky P, Klos D, et al. Long-term survival after resections for pancreatic ductal adenocarcinoma. Single centre study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016;160:280−6.

8. Wolfrum F, Vogel I, Fandrich F, et al. Detection and clinical implications of minimal residual disease in gastro-intestinal cancer. Langenbeck´s Archives of Surgery 2005;390:430−41.

9. Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nature Reviews Cancer 2008;8:329−40.

10. Nagrath S, Jack RM, Sahai V, et al. Opportunities and challenges for pancreatic circulating tumor cells. Gastroenterology 2016;151:412−26.

11. Xie ZB, Yao L, Jin C, et al. Circulating tumor cells in pancreatic cancer patients: efficacy in diagnosis and value in prognosis. Discov Med 2016;22:121−8.

12. Zhou J, Hu L, Yu Z, et al. Marker expression in circulating cancer cells of pancreatic cancer patients. J Surg Res. 2011;171:631−6.

13. Uchikura K, Takao S, Nakajo A, et al. Intraoperative molecular detection of circulating tumor cells by reverse transcription-polymerase chain reaction in patients with biliary-pancreatic cancer is associated with hematogenous metastasis. Ann Surg Oncol 2002;9:364−70.

14. Mataki Y, Takao S, Maemura K, et al. Carcinoembryonic antigen messenger RNA expression using nested reverse transcription-PCR in the peripheral blood during follow-up period of patients who underwent curative surgery for biliary-pancreatic cancer: longitudinal analyse. Clin Cancer Res 2004;10:3807−14.

15. Bhat K, Wang F, Ma Q, et al. Advances in biomarker research for pancreatic cancer. Curr Pharm Des 2012;18:2439−51.

16. Tjensvoli K, Nordgard O, Smaaland R. Circulating tumor cells in pancreatic cancer patients: Methods of detection and clinical implications. Int J Cancer 2013;134:1−8.

17. Court CM, Ankety JS, Hou S, et al. Improving pancreatic cancer diagnosis using circulating tumor cells: prospects for staging and single-cell analysis. Expert Rev Mol Diagn 2015;15:1491−1504.

18. Bébarová L, Skalický P, Klos D, et al. Přežívání pacientů s radikálně neresekabilním karcinomem pankreatu. Rozhl Chir 2016;95:222−6.

19. Kiele P, Koch M. Minimal residual disease in gastrointestinal cancer. Semin. Surg Oncol 2001;20:282–93.

20. Havlík R, Srovnal J, Klos D, et al. Occult tumour cells in peritoneal lavage are a negative prognostic factor in pancreatic cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013;157:233−8.

21. Vogel I, Krüger U, Marxsen J, et al. Disseminated tumor cells in pancreatic cancer patients detected by immunocytology: a new prognostic factor. Clin Cancer Res 1999;5:593−9.

22. Bidard FC, Huguet F, Louvry C, et al. Circulating tumor cells in locally advanced pancreatic adenocarcinoma: the ancillary CirCe 07 study to the Lap 07 trial. Ann Oncol 2013;24:2057−61.

23. Albuquerque A, Kubisch I, Breier G, et al. Multimarker gene analysis of circulating tumor cells in pancreatic cancer patients: a feasibility study. Oncology 2012;82:3−10.

24. Herreros-Villanueva M, Bujanda L. Non-invasine biomarkers in pancreatic cancer diagnosis: What we need versus what we have. Ann Transl Med 2016;4:134−41.

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