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Fractional uptake of circulating tumor cells into liver-lung compartments during curative resection of periampullary cancer.

Journal article
Authors Caroline Vilhav
Cecilia Engström
Peter Naredi
Ann Novotny
Johan Bourghardt Fagman
Britt-Marie Iresjö
Annika Gustafsson Asting
Kent Lundholm
Published in Oncology letters
Volume 16
Issue 5
Pages 6331-6338
ISSN 1792-1074
Publication year 2018
Published at Institute of Clinical Sciences, Department of Surgery
Pages 6331-6338
Language en
Keywords circulating tumor cells, portal blood, periampullary cancer, isoflux, flow cytometry
Subject categories Surgery, Cell and Molecular Biology


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. The aim of the present study was to demonstrate a statistically significant portal-arterial difference of CTCs during curative resection of periampullary cancer. A commercially available instrument (IsofluxR) was used to quantify blood content of CTC in 10 patients with periampullary cancer according to preoperative diagnostics. 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. Quantitative CTC analyses were performed according to standardized protocols for immune-magnetic enrichment of CTC. Flow cytometry was applied for qualitative evaluations of various CTC markers in 7 patients. There was a statistically significant difference in the number of CTCs collected in the portal blood [58±14 cells per 100 ml; mean ± standard error (SE)] vs. arterial blood [24±7 cells per 100 ml (SE), P<0.025]. 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. Complications in the collection of portal blood were not observed. 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.

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