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Endoscopy
DOI: 10.1055/a-2535-7440
Innovations and brief communications

Portal versus peripheral circulating tumor cells as prognostic biomarkers in patients with stage I-III pancreatic ductal adenocarcinoma

Thaninee Prasoppokakorn 
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Roongruedee Chaiteerakij
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Areeya Buntho
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Praewphan Ingrungruanglert
2   Center of Excellence in Stem cell and Cell Therapy, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
3   Excellence Center for Stem Cell and Cell Therapy, King Chulalongkorn Memorial Hospital,, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
,
Nipan Israsena
2   Center of Excellence in Stem cell and Cell Therapy, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
4   Excellence Center for Stem Cell and Cell Therapy, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
,
Wiriyaporn Rittitid
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
5   Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
,
Phonthep Angsuwatcharakon 
6   Anatomy, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Parit Mekaroonkamol
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Pradermchai Kongkam 
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
,
Rungsun Rerknimitr 
1   Division of Gastroenterology, Department of Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand (Ringgold ID: RIN65103)
5   Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand (Ringgold ID: RIN26683)
› Author AffiliationsSupported by: The Second Century Fund (C2F), Chulalongkorn University
Supported by: Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology annual fund, Chulalongkorn University

Clinical Trial: Registration number (trial ID): TCTR20210202006, Trial registry: Thai Clinical Trials Registry (https://www.clinicaltrials.in.th/), Type of Study: Single-center prospective, interventional cohort study
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Background: Portal venous circulating tumor cells (CTCs) detection may better reflect vascular metastasis and predict micro-metastasis risk in PDAC than peripheral blood. We hypothesize that portal CTCs could better represent micro-metastasis and predict survival in PDAC patients. Methods: A single-center, prospective cohort study of patients with stage I-III PDAC was conducted. Portal venous blood was obtained via EUS-guided sampling, and peripheral blood was collected on the same day. CTCs were detected using EpCAM and mucin1 antibodies and reported as cells/8mL of blood. Results: Among 35 patients, portal and peripheral CTC detection rates were 94.3% and 82.9%, respectively. Advanced PDAC with loco-regional metastasis had higher portal CTCs than less aggressive disease (p<0.05), while peripheral CTCs showed no significant differences. During the 50-month follow-up, patients with portal CTCs≥8 had poorer survival (6.1 vs. 19.0 months, p=0.001) and patients with peripheral CTCs≥3 also had poorer survival (4.6 vs. 14.2 months, p=0.002). In multivariable analysis, both portal CTCs≥8 and peripheral CTCs≥3 showed significant adjusted associations with survival (aHRs 3.39 and 2.71; p=0.009 and 0.020). Conclusion: Higher CTC counts in both portal and peripheral systems were significantly associated with poorer survival in stage I-III PDAC; however, only portal CTCs reflected tumor aggression and loco-regional metastasis.



Publication History

Received: 26 August 2024

Accepted after revision: 07 February 2025

Accepted Manuscript online:
07 February 2025

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