title: Circulating tumor microemboli (CTM) and vimentin+ circulating tumor cells (CTCs) detected by a size-based platform predict worse prognosis in advanced colorectal cancer patients during chemotherapy.
abstract: BACKGROUND
  Circulating tumor cells (CTCs) detected in peripheral blood (PB) of cancer patients can be identified as isolated CTCs and circulating tumor microemboli (CTM). This study aimed to evaluate the prognostic value of CTM detection and CTC phenotype in advanced colorectal cancer (CRC) patients during chemotherapy.
  
  
  METHODS
  A size-based platform for CTC isolation was applied. PB samples (5 ml) from 98 advanced CRC patients during 2-6 cycles chemotherapy were collected for CTC detection, and CTC count was correlated to patient's clinicopathological characteristics and clinical outcome. And CTC phenotype was measured by immunofluorescent staining and evaluate the predictive significance on survival in 32 CTCs-positive patients with advanced CRC.
  
  
  RESULTS
  Forty-eight of 98 patients were CTCs-positive, including 18 CTM-positive patients, and CTC detection was positively correlated with lymphatic invasion (P= 0.049), TNM stage (P= 0.023), and serum CEA level (P= 0.014). Moreover, Kaplan-Meier survival and Cox regression analyses revealed that the presence of CTCs was an independent factor for poor PFS and OS (P< 0.05) in advanced CRC patients during chemotherapy, and CTM-positive patients had shooter survival than isolated CTCs-positive patients (P< 0.05). Furthermore, patients with vimentin+ isolated CTCs/CTM had shorter PFS and OS compared with CK+ CTCs (P< 0.05).
  
  
  CONCLUSIONS
  This study provided evidence that the presence of CTCs was positively correlated with poor prognosis, and furthermore, CTM and vimentin+ CTCs predicted poorer survival, which indicated that CTM and vimentin+ CTCs detected by a sensitive platform could be used to improve prognostic value of CTCs in advanced CRC patients under treatment.
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Dejun
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Wuhan YZY Medical Science & Technology Co., Ltd., Wuhan, 430075 Hubei People's Republic of China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ma
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Huang
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Jin
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Dai
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Xiumei
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Wuhan YZY Medical Science & Technology Co., Ltd., Wuhan, 430075 Hubei People's Republic of China.
authors.forename: Shaoyi
authors.initials: S
authors.lastname: Huang
authors.affiliation: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
keywords: Circulating tumor cells; Circulating tumor microemboli; Colorectal cancer; Survival; Vimentin