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Cluster circulating tumor cells in surgical cases of lung cancer



A cancer lesion sheds tumor cells into the circulating blood as circulating tumor cells (CTCs). Since cluster CTCs have been considered as precursor lesions of metastasis, their clinical implication was investigated in this study according to the preoperative status of cluster CTC detection in surgical cases of clinically early-stage lung cancer.


Among 104 surgical patients of early-stage lung cancer, CTCs were extracted from the peripheral blood before surgery using a micro-pore size selection method (ScreenCell®) and diagnosed microscopically. Implications of detecting cluster CTC were assessed according to the prognosis and clinicopathological characteristics.


The status of CTC detection was not detected in 77 cases (74.0%), single CTC only detection in 7 cases (6.7%), and cluster CTC detected in 20 cases (19.2%). Patients with cluster CTCs exhibited significantly lower recurrence-free survival and overall survival than did patients of other groups. In addition, in hazard ratio analysis, the hazard ratios were independent of other predictors of poor prognosis, and detection of cluster CTCs was associated with predictors of poor prognosis.


Cluster CTCs were detected in cases where the original lung cancer lesion had clinical predictors of poor prognosis and were independent negative predictors of survival.

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The authors thank Dr. Hiroshi Maruyama and Dr. Yuko Torii (Department of Pathology, Hoshigaoka Medical Center) for their contributions to the pathological diagnoses.


This research was supported by a Grant-in-Aid for Scientific Research (B) from the Japan Ministry of Education, Science, Sports and Culture (Grant No. 25293301) and a JRF (Japanese Respiratory Foundation) (Grant No. 2019).

Author information




NS: Materials and data collection and analysis, and writing manuscript. YS and TN: Materials and data collection, and discussion over the results. TK, MY, and ST: Discussion over the results.

Corresponding author

Correspondence to Noriyoshi Sawabata.

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The authors declare no conflicts of interest associated with this manuscript.

Ethical approval

This investigation was approved by the institutional review board of the Hoshigaoka Medical Center (No. 1519).

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All patients provided their informed consent to participate in this study.

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Sawabata, N., Susaki, Y., Nakamura, T. et al. Cluster circulating tumor cells in surgical cases of lung cancer. Gen Thorac Cardiovasc Surg 68, 975–983 (2020).

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  • Circulating tumor cell
  • Lung cancer
  • Surgery