title: Clinical Significance of Circulating Tumor Microemboli as a Prognostic Marker in Patients with Pancreatic Ductal Adenocarcinoma.
abstract: BACKGROUND
  Characterization of circulating tumor cells (CTCs) has been used to provide prognostic, predictive, and pharmacodynamic information in many different cancers. However, the clinical significance of CTCs and circulating tumor microemboli (CTM) in patients with pancreatic ductal adenocarcinoma (PDAC) has yet to be determined.
  
  
  METHODS
  In this prospective study, CTCs and CTM were enumerated in the peripheral blood of 63 patients with PDAC before treatment using anti-EpCAM (epithelial cell adhesion molecule)-conjugated supported lipid bilayer-coated microfluidic chips. Associations of CTCs and CTM with patients' clinical factors and prognosis were determined.
  
  
  RESULTS
  CTCs were abundant [mean (SD), 70.2 (107.6)] and present in 81% (51 of 63) of patients with PDAC. CTM were present in 81% (51 of 63) of patients with mean (SD) 29.7 (1101.4). CTM was an independent prognostic factor of overall survival (OS) and progression free survival (PFS). Patients were stratified into unfavorable and favorable CTM groups on the basis of CTM more or less than 30 per 2 mL blood, respectively. Patients with baseline unfavorable CTM, compared with patients with favorable CTM, had shorter PFS (2.7 vs 12.1 months; P < 0.0001) and OS (6.4 vs 19.8 months; P < 0.0001). Differences persisted if we stratified patients into early and advanced diseases. The number of CTM before treatment was an independent predictor of PFS and OS after adjustment for clinically significant factors.
  
  
  CONCLUSIONS
  The number of CTM, instead of CTCs, before treatment is an independent predictor of PFS and OS in patients with PDAC.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;
authors: Ming-Chu
authors: MC
authors: Chang
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; yutingchang@ntu.edu.tw whlee@gate.sinica.edu.tw.
authors: Yu-Ting
authors: YT
authors: Chang
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan;
authors: Jia-Yang
authors: JY
authors: Chen
authors: Departments of Pathology.
authors: Yung-Ming
authors: YM
authors: Jeng
authors: Surgery, and.
authors: Ching-Yao
authors: CY
authors: Yang
authors: Surgery, and.
authors: Yu-Wen
authors: YW
authors: Tien
authors: Oncology, National Taiwan University Hospital, Taipei, Taiwan;
authors: Shih-Hung
authors: SH
authors: Yang
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan;
authors: Huai-Lu
authors: HL
authors: Chen
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan;
authors: Ting-Yuan
authors: TY
authors: Liang
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan;
authors: Chien-Fang
authors: CF
authors: Wang
authors: Department of Biological Chemistry, University of California, Irvine, Irvine, CA;
authors: Eva Y H P
authors: EY
authors: Lee
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan;
authors: Ying-Chih
authors: YC
authors: Chang
authors: Genomics Research Center, Academia Sinica, Taipei, Taiwan; Taiwan Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan. yutingchang@ntu.edu.tw whlee@gate.sinica.edu.tw.
authors: Wen-Hwa
authors: WH
authors: Lee
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D014408:Biomarkers, Tumor