American Surgical Association

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Circulating Tumor Cells Dynamics in Pancreatic Adenocarcinoma Correlate with Disease Status: Data from a Prospective Trial
Georgios Gemenetzis*, Vincent P. Groot*, Jun Yu*, Ding Ding*, Jonathan A. Teinor*, Ammar A. Javed*, Laura D. Wood*, Richard A. Burkhart*, John L. Cameron, Martin A. Makary*, Matthew J. Weiss*, Jin He*, Christopher L. Wolfgang
Johns Hopkins University School of Medicine, Baltimore, MD

Objectives: Previous retrospective studies demonstrate that circulating tumor cell (CTCs) subtypes in patients with pancreatic adenocarcinoma (PDAC) correlate with disease-specific survival. Herein, we report results of a prospective observational trial on CTC dynamics to assess their clinical significance.
Methods: The CLUSTER trial is a prospective longitudinal study on PDAC CTC dynamics (NCT02974764). Multiple peripheral blood samples are collected from 160 consecutively enrolled patients with PDAC diagnosis. CTCs are isolated and characterized by immunofluorescence.
Results: Two major CTC subtypes were identified in all patients: epithelial CTCs (eCTCs) and mesenchymal CTCs (mCTCs). Patients who received neoadjuvant chemotherapy have significantly lower total CTCs (tCTCs) and mCTCs, compared to untreated patients eligible for upfront resection (p<0.001). In multivariable logistic regression analysis, preoperative numbers of tCTCs and mCTCs were the only predictors of early recurrence and disease-associated mortality, within 12 months from surgery (p=0.03, Table 1). Surgical resection of the primary tumor results in significant reduction, but not disappearance, of CTC burden across all cell subtypes (p<0.001). Longitudinal monitoring of CTCs postoperatively shows an increase in CTC numbers within a median time of two months, prior to radiological evidence of disease recurrence.
Conclusions: We report novel findings regarding CTCs from a large prospective trial in patients undergoing PDAC resection. CTC dynamics reflect progression of disease, providing important information on clinical outcomes, not available by current tumor markers and imaging.

logOR95% CIp value
Age, years-0.11-0.26 - 0.040.15
Sex, male0.93-1.68 - 3.550.46
Smoking Hx, present-0.25-1.49 - 0.970.66
BMI, kg/m2-0.02-0.27 - 0.230.86
Tumor site, R pancreas-0.07-2.28 - 2.130.94
CA 19-9, >67.8 U/mL-0.18-2.27 - 1.910.86
Tumor size, >3cm1.78-1.09 - 4.650.21
Preoperative tCTCs, >16/mL of blood3.080.42 - 5.740.03
Preoperative mCTCs, >3/mL of blood2.26-0.17 - 4.70.06

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