| Objective: 1.To study the diagnostic significance of CTCs determined by SE-iFISH platform in pancreatic cancer patients.2.To study the prognostic significance and risk assessment of CTCs in pancreatic cancer patients.Methods: From September 2013 to September 2015,25 qualified invasive pancreatic ductal adenocarcinoma patients(pancreatic cancer below also referred to this item),1 colloid carcinoma,and 20 healthy controls were enrolled in this study.Circulating tumor cells were detected by a novel platform SE-iFISH,which combined the subtraction enrichment and immunostaining-fluorescence in situ hybridization.Immunostaining of CK,CD45,DAPI and FISH with the centromere of chromosome 8(CEP8)were utilized to identify CTCs.Cells with features of CK+/CD45-/DAPI+/CEP8=2,CK+/CD45-/DAPI+/CEP8>2,CK-/CD45-/DAPI+/CEP8>2 were defined as pancreatic CTCs.The Kaplan-Meier method and Cox proportional hazards model were used to analyze the relationship of CTC level and other clinicopathological factors with pancreatic cancer clinical outcomes.Results: The median CTC count in pancreatic cancer patients was significantly higher than the healthy controls(3 CTCs/7.5ml vs 0 CTCs/7.5ml,P<0.001).When the cutoff value was set as 2 CTCs/7.5ml,the Yourdon's index was highest,yielding a sensitivity of 88% and a specialty of 90%,respectively.Therefore,a CTC-positive patient was defined as one whose CTC count in 7.5 mL peripheral venous blood was no less than 2.The detection rate of pancreatic cancer reached 100% by combining CTC?2/7.5mll and CA19-9?37U/ml.The positive rate of CTCs in stage I-II and stage III-IV were 92.3%(12/13)and 83.3%(10/12),with no significant difference between them(P=0.593).The Spearman correlation(R)between CA19-9 level and CTC level was 0.005(P=0.982),CA19-9 and CTC were relatively independent parameters.Various levels of CTC and CA19-9 were applied to explore the association with overall survival.Pancreatic cancer patients with CTC < 3/7.5ml had substantially better overall survival(OS)compared with these with CTC?3/7.5ml(median OS,15.2 vs 10.2 months;P=0.023).Several clinipathological factors,namely age,TNM stage,CA19-9 level and CTC count were included in the multivariate Cox proportional hazards regression analysis.The results showed that CTC?3/7.5ml(HR,4.547;95% CI,1.323-15.625;P=0.016)and ?-? stage(HR,2.742;95% CI,1.245-6.041;P=0.012)were independent risk factors for worse OS.Conclusion: Our current data showed that CTCs could be detected in pancreatic cancer patients in various stages,whether localized,locally advanced and metastatic.Besides,CTCs have shown the potential implication in predicting prognosis of pancreatic cancer. |
PDF Full Text Request