title: Circulating tumour cells and outcome in non-metastatic colorectal cancer: a prospective study.
abstract: BACKGROUND
  Circulating tumour cells (CTC) in the blood have been accepted as a prognostic marker in patients with metastatic colorectal cancer (CRC). Only limited data exist on the prognostic impact of CTC in patients with early stage CRC using standardised detection assays. The aim of this study was to elucidate the role of CTC in patients with non-metastatic CRC.
  
  
  METHODS
  A total of 287 patients with potentially curable CRC were enrolled, including 239 patients with UICC stage I-III. CTC were measured in the blood using the CellSearch system preoperatively and on postoperative days 3 and 7. The complete patient group (UICC I-IV) and the non-metastatic cohort (UICC I-III) were analysed independently. Patients were followed for 28 (0-53) months. Prognostic factors for overall and progression-free survival were analysed using univariate and multivariate analyses.
  
  
  RESULTS
  CTC were detected more frequently in patients with metastatic disease. No clinicopathological variables were associated with CTC detection in non-metastatic patients. CTC detection (⩾1 CTC per 7.5 ml blood) in the blood was significantly associated with worse overall survival (49.8 vs 38.4 months; P<0.001) in the non-metastatic group (UICC I-III), as well as in the complete cohort (48.4 vs 33.6 months; P<0.001). On multivariate analysis CTC were the strongest prognostic factor in non-metastatic patients (hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.3-13.6) as well as in the entire study group (HR 5.6; 95% CI 2.6-12.0).
  
  
  CONCLUSIONS
  Preoperative CTC detection is a strong and independent prognostic marker in non-metastatic CRC.
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: U
authors: U
authors: Bork
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: N N
authors: NN
authors: Rahbari
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: S
authors: S
authors: Schölch
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: C
authors: C
authors: Reissfelder
authors: 1] Department of General, GI and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany [2] Department of Cancer Biology, Metastasis Research Center, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: C
authors: C
authors: Kahlert
authors: Department of General, GI and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: M W
authors: MW
authors: Büchler
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: J
authors: J
authors: Weitz
authors: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany.
authors: M
authors: M
authors: Koch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor