title: Molecular detection of persistent postoperative circulating tumour cells in stages II and III colon cancer patients via multiple blood sampling: prognostic significance of detection for early relapse.
abstract: BACKGROUND
  The purpose of this study was to detect postoperative persistent circulating tumour cells (CTCs) in stages II and III colon cancer patients undergoing curative resection and so identify a subgroup of patients who are at high risk for early relapse.
  
  
  METHODS
  Four mRNA molecular markers including human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen (CEA) mRNA were used to detect CTCs in 141 stages II and III colon cancer patients undergoing curative resection to determine the significance of CTCs in postoperative early relapse.
  
  
  RESULTS
  Out of 141 patients, postoperative early relapse and non-early relapse/no relapse was found in 48 (34.0%) patients and 93 (66.0%) patients, respectively. Univariately, postoperative early relapse was significantly correlated with lymph node metastasis (P=0.025), vascular invasion (P=0.002), perineural invasion (P=0.001), laparoscopic surgery (P=0.019), high postoperative serum CEA levels (P=0.001), and presence of persistent postoperative CTCs (P<0.001). Using a multivariate proportional hazards regression analysis, the presence of perineural invasion (P=0.034; HR, 1.974; 95% CI: 1.290-3.861), high postoperative serum CEA levels (P=0.020; HR, 2.377; 95% CI: 1.273-4.255), and the presence of persistent postoperative CTCs (P<0.001; HR, 11.035; 95% CI: 4.396-32.190), were demonstrated to be independent predictors for postoperative early relapse. Furthermore, the presence of persistent postoperative CTCs was strongly correlated with a poorer disease-free and overall survival (both P<0.001).
  
  
  CONCLUSIONS
  This study suggests that molecular detection of persistent postoperative CTCs is a prognostic predictor of early relapse in UICC stage II/III colon cancer patients, and thus could help to define patients with this tumour entity for an enhanced follow-up and therapeutic program.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Lu
authors.forename: Y-H
authors.initials: YH
authors.lastname: Uen
authors.forename: H-L
authors.initials: HL
authors.lastname: Tsai
authors.forename: S-C
authors.initials: SC
authors.lastname: Chuang
authors.forename: M-F
authors.initials: MF
authors.lastname: Hou
authors.forename: D-C
authors.initials: DC
authors.lastname: Wu
authors.forename: S-H Hank
authors.initials: SH
authors.lastname: Juo
authors.forename: S-R
authors.initials: SR
authors.lastname: Lin
authors.forename: J-Y
authors.initials: JY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001800:Blood Specimen Collection; D002272:Carcinoembryonic Antigen / Q000097:blood / Q000235:genetics; D003110:Colonic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D053539:Keratin-19 / Q000235:genetics; D053554:Keratin-20 / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D011184:Postoperative Period; D011379:Prognosis; D012333:RNA, Messenger / Q000032:analysis; D019098:Telomerase / Q000235:genetics
chemical_list: D002272:Carcinoembryonic Antigen; D053539:Keratin-19; D053554:Keratin-20; D012333:RNA, Messenger; C509186:TERT protein, human; D019098:Telomerase