Abstract
Pancreatic cancer is the fourth leading cause of cancer-related death in the USA and Europe; early symptoms and screenings are lacking, and it is usually diagnosed late with a poor prognosis. Circulating tumor cells (CTCs) have been promising new biomarkers in solid tumors. In the last twenty years (1999–2019), 140 articles have contained the key words “Circulating tumor cells, pancreatic cancer, prognosis and diagnosis.” Articles were evaluated for the use of CTCs as prognostic markers and their correlation to survival in pancreatic ductal adenocarcinoma (PDAC). In the final selected 17 articles, the CTC detection rate varied greatly between different enrichment methodologies and ranged from 11% to 92%; the majority of studies used the antigen-dependent CellSearch© system for CTC detection. Fifteen of the reviewed studies showed a correlation between CTC presence and a worse overall survival. The heterogeneity of CTC-detection methods and the lack of uniform results hinder a comparison of the evaluated studies. However, CTCs can be detected in pancreatic cancer and harbor a hope to serve as an early detection tool. Larger studies are needed to corroborate CTCs as valid biomarkers in pancreatic cancer.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the United States and Europe [1,2]
This review addresses the role of circulating tumor cells in pancreatic cancer as prognostic and diagnostic tools
The clinical utility of circulating tumor cells (CTCs) as prognostic markers and as risk factors for disease recurrence have been found in patients with PDAC in pilot and prospective midsize studies
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the United States and Europe [1,2]. Function as diagnostic tool alone—but high CA19.9 levels often indicate advanced tumors [5] The concern regarding this biomarker is that an elevated expression of CA19.9 can be found in various benign (pancreatitis, acute cholangitis and cirrhosis) and malignant (colorectal cancer, gastric cancer, bladder cancer and uterine squamous cell carcinoma) diseases in addition to PDAC, resulting in its non-specificity. Other blood-based biomarkers are not routinely used or have not yet entered clinical practice Liquid biopsies, such as circulating tumor DNA (ctDNA), exosomes, plasma proteomics and circulating tumor cells (CTCs) have been investigated for over a decade and have presented encouraging results, which are partly discussed in this review; clear clinical recommendations for patients with PDAC are still missing. We discuss the problems of inhomogeneous CTC isolation and analysis, and we highlight potential research perspectives
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