Role of Phenotypes of Circulating Tumor Cells in the Diagnosis and Treatment of Colorectal Cancer

• Main Authors: Zhong Y, Ma T, Qiao T, Hu H, Li Z, Luo K, Wang Y, Tang Q, Wang G, Huang R, Wang X
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-09-01
• Series: Cancer Management and Research
• Subjects: circulating tumor cells; colorectal cancer; surgery; emt
• Online Access: https://www.dovepress.com/role-of-phenotypes-of-circulating-tumor-cells-in-the-diagnosis-and-tre-peer-reviewed-fulltext-article-CMAR
• ISSN: 1179-1322

Yuchen Zhong,1,2 Tianyi Ma,1 Tianyu Qiao,1 Hanqing Hu,1 Zhengliang Li,1 Kangjia Luo,1 Yuliuming Wang,1 Qingchao Tang,1 Guiyu Wang,1,2 Rui Huang,1 Xishan Wang3 1Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China; 2Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310002, People’s Republic of China; 3Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Cancer, Beijing, 100021, People’s Republic of ChinaCorrespondence: Guiyu Wang; Rui HuangDepartment of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of ChinaTel/Fax [phone]Email [e-mail]; [e-mail]: To investigate the relationship between circulating tumor cells (CTCs) and their subpopulations and colorectal cancer (CRC). To explore the application of CTCs’ numbers and positive rates in the diagnosis and treatment of CRC, and to assess the effect of surgery on CTCs numbers and positivity.Methods: We identified CTCs using the CanPatrol technique after enrollment. Peripheral blood samples were collected from 74 CRC patients before anti-tumor treatment. CTCs can be divided into the following three phenotypes: epithelial CTCs (E-CTCs) (EpCAM+, Vimentin-), mesenchymal CTCs (M-CTCs) (EpCAM-, Vimentin+), and mixed CTCs (E/M-CTCs) (EpCAM+, Vimentin+). CTCs and the proportion of subtypes were statistically compared with clinicopathological characteristics.Results: The positive rate of M-CTCs was significantly higher in patients with tumor size ≥ 5 cm (85.7% vs 49.1%, P = 0.004) and carcinoembryonic antigen (CEA) > 5 ng/mL (83.3% vs 51.0% p = 0.024). Moreover, the T stage (T1 0, T2 33.3%, T3 59.4%, T4 100%, p < 0.0005) and TNM stage (stage I 11.8%, stage II 79.2%, stage III 64.3%, stage IV 100%, p < 0.0005) were correlated with the positive rate of M-CTCs. We also found that the proportion of M-CTCs was correlated with the T stage (p < 0.0005) and TNM stage (p=0.0200), but not with the N stage (p=0.6889). In survival analysis, M-CTCs > 1 were found associated with worse disease-free survival (p=0.007). After treatment, the number and proportion of CTCs and M-CTCs were significantly reduced.Conclusion: The positive rate of M-CTCs was associated with tumor size, T stage, TNM stage, vascular invasion, and CEA. As the disease progressed, the proportion of M-CTCs gradually increased, and the survival performance was worse in patients with a high positive rate of M-CTCs.Keywords: circulating tumor cells, colorectal cancer, surgery, EMT