Abstract LB-438: Circulating tumor cells in pancreatic carcinoma: negative prognostic factor

Abstract

Abstract Background: The aim of this ongoing study was to evaluate the hypothesis that circulating tumor cells (CTCs) are negative prognostic factor in pancreatic carcinoma. Pancreatic carcinoma is one of the most aggressive malignancies with a poor prognosis. Assessment of CTCs could prevent aggressive surgery in patients with advanced systemic dissemination. Patients and methods: This was a prospective study to test the presence of CTCs in systemic blood, tumor draining blood, bone marrow and peritoneal lavage of 136 pancreatic carcinoma patients (53 females, 83 males, mean age 63 years, ranging from 37 - 84 years old) at the time of surgery using real-time RT-PCR for carcinoembryonic antigen (CEA), epidermal growth factor receptor 1 (EGFR1) and human telomerase (hTERT). Gene expression of tested markers was correlated with clinical/pathological characteristics and overall survival. Results: Overall, 92 of 136 (67.6%) pancreatic carcinoma patients died, the overall survival median was 10.3 months. 66 of 136 (48.5%) of patients underwent curative surgery (R0 surgery). A significant association between EGFR and hTERT expression levels in the tumor draining blood and clinical stage was found, where patients with advanced disease have a higher expression of EGFR or hTERT in the tumor draining blood, than patients with lower clinical stage (p<0.004, resp. p<0.001). In addition, significant association between CEA expression levels in the peritoneal lavage and the clinical stage was found (p<0.03). The pancreatic carcinoma patients with the presence of CTCs/DTCs in tumor draining blood and bone marrow using hTERT had significantly shorter overall survival (p<0.042; HR=1.44 [95% CI: 0.85-2.45], resp. p<0.045; HR=1.55 [95% CI: 1.01-2.34]). In addition, patients with the presence of occult tumor cells detected in the peritoneal lavage using CEA and/or EGFR had significantly shorter overall survival (p<0.001; HR=2.14 [95% CI: 1.30-3.55]). Interestingly, the patients with presence of CTCs detected in either peripheral blood, tumor draining blood or peritoneal lavage using combination of CEA and/or EGFR and/or hTERT had also significantly shorter overall survival (p<0.07; HR=1.42 [95% CI: 0.94-2.16], resp. p<0.0006; HR=1.95 [95% CI: 1.20-3.18], resp. p<0.01; HR=1.62 [95% CI: 0.98-2.67]). Conclusion: The present ongoing study demonstrates that the presence of CTCs is a negative prognostic factor in pancreatic carcinoma patients. CTCs detection using PCR based methods can identify patients with advance disease for whom radical surgery is of small benefit. Prospective studies should confirm usefulness of this method for the selection of patients for radical surgery Acknowledgements: Supported by grants IGA MZ NS 9937-4, MPOTIP FR-TI1/525, IGA UP LF_2011_018 and CZ.1.05/2.1.00/01.0030 Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-438. doi:1538-7445.AM2012-LB-438