title: Circulating Tumor Cells Count and Morphological Features in Breast, Colorectal and Prostate Cancer.
abstract: Presence of circulating tumor cells (CTC) in patients with metastatic breast, colorectal and prostate cancer is indicative for poor prognosis. An automated CTC (aCTC) algorithm developed previously to eliminate the variability in manual counting of CTC (mCTC) was used to extract morphological features. Here we validated the aCTC algorithm on CTC images from prostate, breast and colorectal cancer patients and investigated the role of quantitative morphological parameters.
  
  
  
  Stored images of samples from patients with prostate, breast and colorectal cancer, healthy controls, benign breast and colorectal tumors were obtained using the CellSearch system. Images were analyzed for the presence of aCTC and their morphological parameters measured and correlated with survival.
  
  
  
  Overall survival hazard ratio was not significantly different for aCTC and mCTC. The number of CTC correlated strongest with survival, whereas CTC size, roundness and apoptosis features reached significance in univariate analysis, but not in multivariate analysis. One aCTC/7.5 ml of blood was found in 7 of 204 healthy controls and 9 of 694 benign tumors. In one patient with benign tumor 2 and another 9 aCTC were detected.
  
  
  
  CTC can be identified and morphological features extracted by an algorithm on images stored by the CellSearch system and strongly correlate with clinical outcome in metastatic breast, colorectal and prostate cancer.
authors.affiliation: Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, Enschede, The Netherlands.
authors.forename: Sjoerd T
authors.initials: ST
authors.lastname: Ligthart
authors.forename: Frank A W
authors.initials: FA
authors.lastname: Coumans
authors.forename: Francois-Clement
authors.initials: FC
authors.lastname: Bidard
authors.forename: Lieke H J
authors.initials: LH
authors.lastname: Simkens
authors.forename: Cornelis J A
authors.initials: CJ
authors.lastname: Punt
authors.forename: Marco R
authors.initials: MR
authors.lastname: de Groot
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Attard
authors.forename: Johann S
authors.initials: JS
authors.lastname: de Bono
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.forename: Leon W M M
authors.initials: LW
authors.lastname: Terstappen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001772:Blood Cell Count; D001943:Breast Neoplasms / Q000097:blood / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D010363:Pattern Recognition, Automated; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*