title: Detection of Circulating Tumor Cells at Surgery and at Follow-Up Assessment to Predict Survival After Two-Stage Liver Resection of Colorectal Liver Metastases.
abstract: BACKGROUND
  The presence of circulating tumor cells (CTCs) is negatively associated with survival after resection of colorectal liver metastases (CLM). The current study aimed to determine the prognostic value of CTCs and disseminated tumor cells (DTCs) at the time of surgery and the prognostic value of CTCs at follow-up assessment, for patients scheduled to undergo two-stage hepatectomy with portal vein embolization (PVE) for CLM.
  
  
  METHODS
  Samples were collected at surgery (blood and bone marrow) and at follow-up assessment (blood) for the period 2008 through 2011. In this study, CTCs were detected with the CellSearch system, and DTCs were detected using standard immunocytochemical analysis.
  
  
  RESULTS
  Of 24 patients, 18 completed both stages, and no patients were lost to follow-up. The median overall survival (OS) was 37 months, and the median recurrence-free survival (RFS) was 7 months. At surgery, CTCs were found in nine patients (38 %), and their presence was associated with reduced OS (p < 0.001) and RFS (p = 0.006). Follow-up CTC status was available for 11 patients. All eight patients with positive CTC status experienced recurrence. Two of three patients with negative CTC status remained recurrence free. In seven patients (32 %), DTCs were detected but were not associated with OS or RFS.
  
  
  CONCLUSIONS
  The presence of CTCs at surgery is associated with worse OS and RFS for patients undergoing two-stage hepatectomy with PVE for CLM. Analysis of CTCs should be explored further for their potential to assist in treatment decisions and monitoring for CLM patients.
authors: Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, Oslo, Norway. kristoffer@brudvik.dk.|Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway. kristoffer@brudvik.dk.
authors: Kristoffer Watten
authors: KW
authors: Brudvik
authors: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.|Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway.
authors: Lars Thomas
authors: LT
authors: Seeberg
authors: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors: Harald
authors: H
authors: Hugenschmidt
authors: Department of Pathology, Oslo University Hospital, Oslo, Norway.
authors: Anne
authors: A
authors: Renolen
authors: Department of Pathology, Oslo University Hospital, Oslo, Norway.
authors: Cecilie Bendigtsen
authors: CB
authors: Schirmer
authors: Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors: Cathrine
authors: C
authors: Brunborg
authors: Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, Oslo, Norway.|Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors: Bjørn Atle
authors: BA
authors: Bjørnbeth
authors: Department of Pathology, Oslo University Hospital, Oslo, Norway.
authors: Elin
authors: E
authors: Borgen
authors: Department of Oncology, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Bjørn
authors: B
authors: Naume
authors: Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
authors: Anne
authors: A
authors: Waage
authors: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors: Gro
authors: G
authors: Wiedswang
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D015996:Survival Rate