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Circulating tumor cells predict decreased survival in cholangiocarcinoma

In a prospective study, the presence of circulating tumor cells was found to be associated with a decreased overall survival in patients with cholangiocarcinoma, suggesting it may be a useful biomarker for tumor prediction.

Lewis R. Roberts, MB, ChB, PhD, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., and colleagues reviewed medical records of 88 patients with cholangiocarcinoma (CCA) enrolled at Mayo Clinic, Rochester, between June 2010 and September 2014. To determine if any circulating tumor cells (CTC) were present, blood samples were collected after CCA diagnosis. The CellSearch System (Veridex LLC) was used for detection of CTCs in peripheral blood, according to the research.

Overall, 28% of patients had one or more CTCs (n = 25), 17% had two or more

CTCs (n = 15) and 9% had five or more CTCs (n = 8).

Lewis R. Roberts

Using Cox’s proportional hazards model, researchers found the presence of two or more CTCs (HR = 2.5; 95% CI, 1.1-5.4) and five or more CTCs (HR = 4.1; 95% CI, 1.4-10.8) were both independent predictors of survival. The median survival of patients with two or more CTCs was 5 months compared with 27 months in patients with less than two CTCs (P < .01).

In subgroup analyses, two or more CTCs (HR = 8.2; 95% CI, 1.8-57.5) and five or more CTCs (HR = 7.7; 95% CI, 1.4-42.9) were associated with shorter overall survival among patients with metastasis. The median survival of patients with metastasis with two or more CTCs was 2 months compared with 8 months in patients with less than two CTCs (P < .01).

The researchers also observed a “trend toward association” in five or more CTCs with shorter survival in patients with nonmetastatic CCA (HR = 4.3; 95% CI, 1-13.8). Two or more CTCs (HR = 10.5; 95% CI, 2.2-40.1) and five or more CTCs (HR = 10.2; 95% CI, 1.5-42.3) were both associated with shorter survival among patients with perihilar/distal CCA.

Only five or more CTCs were associated with a shorter survival of patients with intrahepatic CCA (HR = 4.2; 95% CI, 1.1-14.1), not two or more CTCs. The median survival of patients with metastasis with five or more CTCs was 1 month compared with 8 months in patients with less than five CTCs (P < .01).

The researchers concluded: “This study suggests that CTC can serve as a valuable tumor biomarker in CCA. Validation of these findings, including the prognostic role of CTC in specific subgroups of patients observed in different clinical settings, defining the best cutoff of CTC and the role of serial CTC trends in predicting [overall survival] and/or [progression free survival] should be further investigated.” – by Melinda Stevens

Disclosures: Roberts reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.