title: Perioperative cancer cell dissemination detected with a real-time RT-PCR assay for EpCAM is not associated with worse prognosis in pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Epithelial cell adhesion molecule (EpCAM) has been used as surrogate marker for the quantification of circulating tumour cells (CTC). Our aim was to prospectively study the value of a real-time RT-PCR assay for EpCAM detection in the peripheral blood and peritoneal cavity of patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  From 48 patients with PDAC (40 resectable, 8 unresectable) and 10 patients with chronic pancreatitis undergoing pancreatectomy 10 ml of venous blood was drawn preoperatively (PB) and postoperatively (POB, day 1 (D1B), day 7 (D7B) and after 6 weeks (6WB). Of all patients undergoing pancreatectomy, 40 ml peritoneal lavage fluid was taken preoperatively and postoperatively. A real-time RT-PCR assay (TaqMan, ABI Prism 7700) was developed for the detection of EpCAM mRNA. To discriminate between EpCAM-positive and negative samples a cut-off was applied. Median postoperative follow-up was 24.0 months (range: 0.7-41.3).
  
  
  RESULTS
  PB was EpCAM-positive+ in 25% of patients versus 65% of patients in POB (p < 0.0001). EpCAM+ was noted at D1B, D7B and 6WB was found in 28.6%, 23.1% and 23.5% of patients respectively. Preoperative peritoneal lavage fluid was EpCAM+ in 10.3% versus 53.8% of patients postoperatively (p < 0.0001). At none of the time-points, an association was found between EpCAM positivity in blood and/or peritoneal cavity and cancer-specific or disease-free survival. Also, no significant associations were found between clinicopathological variables and perioperative EpCAM positivity.
  
  
  CONCLUSIONS
  Despite a significant increase in EpCAM counts in postoperative blood and peritoneal lavage fluid this was not associated with worse prognosis after pancreatectomy for PDAC.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00495924.
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Gregory
authors.initials: G
authors.lastname: Sergeant
authors.forename: Tania
authors.initials: T
authors.lastname: Roskams
authors.forename: Jos
authors.initials: J
authors.lastname: van Pelt
authors.forename: François
authors.initials: F
authors.lastname: Houtmeyers
authors.forename: Raymond
authors.initials: R
authors.lastname: Aerts
authors.forename: Baki
authors.initials: B
authors.lastname: Topal
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery; D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood / Q000235:genetics* / Q000378:metabolism; D001202:Ascitic Fluid / Q000378:metabolism / Q000473:pathology; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D015815:Cell Adhesion Molecules / Q000097:blood / Q000235:genetics* / Q000378:metabolism; D003199:Computer Systems; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000378:metabolism / Q000473:pathology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D059035:Perioperative Period / Q000009:adverse effects; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D015815:Cell Adhesion Molecules; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule