title: Circulating Tumor Cells as a Biomarker for Preoperative Prognostic Staging in Patients With Esophageal Cancer.
abstract: OBJECTIVE
  We evaluated the prognostic significance of circulating tumor cells (CTCs) in patients with esophageal cancer (EC).
  
  
  BACKGROUND
  Despite the availability of several preoperative diagnostic techniques, accurate pretreatment staging of EC remains challenging.
  
  
  METHODS
  In this single-center, prospective study, peripheral blood samples for CTC analyses were obtained preoperatively from 100 patients who were judged to have resectable EC. CTC detection was performed using the CellSearch System. Data were correlated with clinicopathological parameters and patient outcomes.
  
  
  RESULTS
  CTCs were detected in 18% (18/100) of all eligible patients. Patients with CTCs showed significantly shorter relapse-free (P < 0.001) and overall survival (P < 0.001) than CTC-negative patients. Even in patients with lymph node invasion and without distant metastases (pN+, M0, N = 45), CTC detection indicated significantly worse relapse-free (P < 0.001) and overall survival (P = 0.007). Multivariate analyses of eligible patients identified CTCs as a strong, independent, prognostic indicator of tumor recurrence (hazard ratio, 5.063; 95% confidence interval, 2.233-11.480; P < 0.001) and overall survival (hazard ratio, 3.128; 95% confidence interval, 1.492-6.559; P = 0.003).
  
  
  CONCLUSIONS
  This is the first study to report that CTCs detected by an automated immunomagnetic detection system are independent, prognostic indicators of patients' outcome in EC. Thus, implementation of CTCs may improve accuracy of preoperative staging in EC.
authors.affiliation: Departments of *General, Visceral, and Thoracic Surgery †Tumor Biology, and ‡Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reeh
authors.forename: Katharina E
authors.initials: KE
authors.lastname: Effenberger
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Koenig
authors.forename: Sabine
authors.initials: S
authors.lastname: Riethdorf
authors.forename: Dominique
authors.initials: D
authors.lastname: Eichstädt
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Klaus
authors.initials: K
authors.lastname: Pantel
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies