title: Circulating tumor cells (CTCs) in malignant pleural mesothelioma (MPM).
abstract: OBJECTIVE
  To investigate the diagnostic and prognostic value of circulating tumor cells (CTCs), a potential surrogate of micrometastasis, in malignant pleural mesothelioma (MPM).
  
  
  METHODS
  We prospectively evaluated CTCs in 7.5 mL of peripheral blood sampled from patients with a suspicion of MPM. A semiautomated system was used to capture CTCs with an antibody against the epithelial cell adhesion molecule.
  
  
  RESULTS
  Of 136 eligible patients, 32 were finally diagnosed with nonmalignant diseases (NM), and 104 had MPM. CTCs were detected in 32.7 % (34 of 104) of MPM patients but in only 9.4 % (3 of 32) of NM patients (P = 0.011). The CTC count was significantly higher in MPM patients than in NM patients (P = 0.007), and a receiver operating characteristic (ROC) curve analysis showed an insufficient capability of the CTC test in discrimination between MPM and NM, with an area under ROC curve of 0.623 (95 % confidence interval, 0.523-0.723; P = 0.036). Among MPM patients, CTCs were more frequently detected in patients with epithelioid subtype (39.7 %, 31 of 78) than in those with nonepithelioid subtypes (11.5 %, 3 of 26; P = 0.016). Positive CTCs (CTC count ≥ 1) were a significant factor to predict a poor prognosis among epithelioid patients (median overall survival, 22.3 months for positive CTCs vs. 12.6 months for negative CTCs; P = 0.004) and not in nonepithelioid patients (P = 0.649). A multivariate analysis showed that positive CTCs were a significant and independent factor to predict a poor prognosis (hazard ratio, 2.904; 95 % confidence interval, 1.530-5.511; P = 0.001) for epithelioid MPM patients.
  
  
  CONCLUSIONS
  CTC was a promising marker in diagnosis and prediction of prognosis in MPM, especially in epithelioid MPM.
authors.affiliation: Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Yoneda
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Tanaka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kondo
authors.forename: Masaki
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Takuwa
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tsubota
authors.forename: Ayuko
authors.initials: A
authors.lastname: Sato
authors.forename: Tohru
authors.initials: T
authors.lastname: Tsujimura
authors.forename: Kozo
authors.initials: K
authors.lastname: Kuribayashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fukuoka
authors.forename: Chiharu
authors.initials: C
authors.lastname: Tabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
authors.forename: Seiki
authors.initials: S
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000032:analysis; D019540:Area Under Curve; D015815:Cell Adhesion Molecules / Q000032:analysis; D002452:Cell Count; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000737:chemistry; D010997:Pleural Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D000951:Antigens, Neoplasm; D015815:Cell Adhesion Molecules; D000071858:Epithelial Cell Adhesion Molecule