There are also indications that CTC may have prognostic value in patients with pancreatic cancer ( 8– 10), suggesting the existence of CTC subgroups with aggressively metastasizing phenotypes ( 11, 12), where increased CTC numbers in portal blood predict liver metastases and reduced survival in pancreatic carcinoma ( 13, 14), and colorectal cancer ( 15). Previous research has indicated numbers of CTC in blood to predict disease prognoses in breast, colon and prostate carcinomas ( 5– 7). Hence, there is need for therapy improvements and to understand mechanisms behind metastases to improve postoperative survival of patients with periampullary cancer, since circulating tumor cells (CTC) in patients with gastrointestinal carcinomas are assumed to enter the portal circulation as an initial phase of the metastatic process ( 3, 4). The estimated overall 5-year survival in ductal pancreatic carcinoma is less than 5 per cent ( 2). Pancreatic related cancer is the ninth most common cancer in Western Europe and the fifth common cause of death from cancer ( 1). A significant uptake across liver or lung compartments of potentially malignant tumor CTCs from periampullary carcinoma may represent a model to capture, define and characterize cell clones with metastatic potential in liver and lung tissues following surgical resection. Complications in the collection of portal blood were not observed. A fractional uptake of ≥40% across liver and lung compartments of assumed malignant CTC was estimated to correspond to the appearance of ~410 tumor cells per minute during pancreatic resections based on estimated hepatic blood flow, measured tumor cell mass and tumor cell proliferation activity. There was a statistically significant difference in the number of CTCs collected in the portal blood vs. Flow cytometry was applied for qualitative evaluations of various CTC markers in 7 patients. Quantitative CTC analyses were performed according to standardized protocols for immune-magnetic enrichment of CTC. Portal and arterial blood samples (~8 ml each) were simultaneously collected intra-operatively following surgical dissection prior to division of the pancreas for tumor removal. A commercially available instrument (Isoflux R) was used to quantify blood content of CTC in 10 patients with periampullary cancer according to preoperative diagnostics. The aim of the present study was to demonstrate a statistically significant portal-arterial difference of CTCs during curative resection of periampullary cancer. Circulating tumor cells (CTCs) are able to predict outcome in patients with breast, colon and prostate cancer and appear to be promising biomarkers of pancreatic carcinoma.
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