title: Expression and clinical relevance of epithelial and mesenchymal markers in circulating tumor cells from colorectal cancer.
abstract: Circulating tumor cells (CTCs) with phenotypic hallmarks of epithelial-mesenchymal transition (EMT) reportedly contribute to tumor metastasis in different cancer types. We therefore evaluated the expression of EMT markers in CTCs obtained from a large cohort of Chinese patients with colorectal cancer (CRC) and investigated their clinical relevance. The CanPatrolTM CTC enrichment technique was used to isolate and classify CTCs. CTCs were detected in 1046 of 1203 patients (86.9%), and three phenotypes were identified based on the expression of epithelial and mesenchymal markers: epithelial CTCs, biophenotypic (epithelial/mesenchymal) CTCs, and mesenchymal CTCs. Total CTC numbers positively correlated with both clinical stage and lymph node metastasis and distant metastasis. Furthermore, both biophenotypic and mesenchymal, but not epithelial, CTCs, correlated with the above parameters, suggesting CTCs displaying a mesenchymal phenotype denote more aggressive disease and metastatic potential. This is the first study to demonstrate a significant correlation between CTCs displaying a mesenchymal phenotype and both clinical stage and metastasis in a large cohort of patients with CRC. Our findings suggest that assessment of not only epithelial, but also mesenchymal markers in CTC analyses may offer valuable assistance for tumor staging and metastasis evaluation in patients with CRC.
authors.affiliation: Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ren
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Laboratory Medicine, Sino-UK Circulating Biomarkers' Exploration and Detection Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Cai
authors.affiliation: Department of General surgery, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of General Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
authors.affiliation: SurExam Bio-Tech Co., Guangzhou, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: SurExam Bio-Tech Co., Guangzhou, China.
authors.forename: Shiyang
authors.initials: S
authors.lastname: Wu
authors.affiliation: SurExam Bio-Tech Co., Guangzhou, China.
authors.forename: Suyan
authors.initials: S
authors.lastname: Liu
authors.affiliation: SurExam Bio-Tech Co., Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Laboratory Medicine, Sino-UK Circulating Biomarkers' Exploration and Detection Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of General surgery, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yao
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood* / Q000235:genetics; D000073888:Cell-Free Nucleic Acids / Q000097:blood* / Q000235:genetics; D002681:China; D015179:Colorectal Neoplasms / Q000097:blood* / Q000235:genetics / Q000473:pathology; D058750:Epithelial-Mesenchymal Transition; D006801:Humans; D017403:In Situ Hybridization; D008207:Lymphatic Metastasis; D008856:Microscopy, Fluorescence; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000737:chemistry* / Q000473:pathology; D010641:Phenotype; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D014408:Biomarkers, Tumor; D000073888:Cell-Free Nucleic Acids
keywords: circulating tumor cells; clinical stage; colorectal cancer; epithelial-mesenchymal transition; metastasis