title: Circulating tumor cells in patients with colorectal liver metastasis predict impaired survival.
abstract: OBJECTIVE
  The aim of the study is to assess the prognostic and predictive value of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) in bone marrow (BM) in patients with colorectal liver metastasis referred to surgery.
  
  
  BACKGROUND
  A total of 194 patients were included. Treatment of the patients was decided in a multidisciplinary team.
  
  
  METHODS
  BM aspirates and blood samples were collected at surgery, or in local anesthesia in nonresectable patients. CTCs were disclosed with CellSearch System, DTC with immunocytology.
  
  
  RESULTS
  Liver resection was completed in 153 patients. Forty-one patients were nonresectable, 22 preoperatively and 19 intraoperatively. The median follow-up was 22 (range 1-61) months. Relapse was diagnosed in 103 of the resected patients. Totally, 67 patients died of cancer. CTCs were detected in 19.6% of the patients. CTC positivity was significantly higher in nonresectable (46%) than in resectable patients (11.7%), P < 0.001. 13.8% of the patients had 2 or more CTCs, 31% of the nonresectable and 9.1% of the resectable patients (P = 0.001). Patients with 2 or more CTCs experienced reduced time to relapse/progression, both analyzing all patients (P = 0.002) and analyzing resectable patients (P < 0.001). Two or more CTCs was a strong predictor of progression and mortality in all subgroups of patients, together with more than 3 liver metastases, R1 resection, and extrahepatic disease. DTCs were detected in 9.9% of the patients, but not associated with clinical outcome in resectable patients.
  
  
  CONCLUSIONS
  CTCs predict nonresectability and impaired survival. CTC analysis should be considered as a tool for decision-making before liver resection in these patients.
authors: Departments of *Gastrointestinal Surgery †Biostatistics and Epidemiology ‡Pathology §Oncology, Oslo University Hospital, Oslo, Norway ¶Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway ∥Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Lars Thomas
authors: LT
authors: Seeberg
authors: Anne
authors: A
authors: Waage
authors: Cathrine
authors: C
authors: Brunborg
authors: Harald
authors: H
authors: Hugenschmidt
authors: Anne
authors: A
authors: Renolen
authors: Ingun
authors: I
authors: Stav
authors: Bjørn Atle
authors: BA
authors: Bjørnbeth
authors: Kristoffer W
authors: KW
authors: Brudvik
authors: Elin F
authors: EF
authors: Borgen
authors: Bjørn
authors: B
authors: Naume
authors: Gro
authors: G
authors: Wiedswang
mesh_terms: D019046:Bone Marrow Neoplasms / Q000401:mortality / Q000556:secondary; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018450:Disease Progression; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D012307:Risk Factors