Annals of Surgical Oncology

, 15:2120 | Cite as

Persistent Presence of Postoperative Circulating Tumor Cells is a Poor Prognostic Factor for Patients with Stage I–III Colorectal Cancer after Curative Resection

  • Yih-Huei Uen
  • Chien-Yu Lu
  • Hsiang-Lin Tsai
  • Fang-Jung Yu
  • Ming-Yii Huang
  • Tian-Lu Cheng
  • Shiu-Ru Lin
  • Jaw-Yuan Wang
Gastrointestinal Oncology



To detect pre- and postoperative circulating tumor cells (CTCs) in stage I–III colorectal cancer (CRC) patients undergoing curative resection and so identify a subgroup of patients who are at high risk for relapse.


Four mRNA molecular markers including human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen mRNA were used to detect CTCs in 438 CRC patients underwent curative resection.


Out of 438 patients, 80 CRC patients were classified to preoperative (−)/postoperative (−), 221 patients were preoperative (+)/postoperative (−), while 137 patients were preoperative (+)/postoperative (+). Univariately, postoperative relapse was significantly correlated with depth of invasion (P = 0.032), lymph node metastasis (P < 0.001), vascular invasion (P = 0.001), perineural invasion (P = 0.013), and persistent presence of CTCs (P < 0.001). Using a multivariate proportional hazards regression analysis, the presence of lymph node metastasis (P = 0.012; HR, 7.652; 95% CI: 4.162–14.827), vascular invasion (P = 0.033; HR, 4.360; 95% CI: 2.793–10.847), and the persistent presence of CTCs (P < 0.001; HR, 29.486; 95% CI: 10.281–87.792) were demonstrated to be independent predictors for postoperative relapse. Combination of these three independent predictors showed that patients with any one positive predictor had a hazard ratio of sevenfold to develop postoperative relapse (P < 0.001; HR, 7.064; 95% CI: 4.354–11.464). Furthermore, the persistent presence of CTCs was strongly correlated with poorer relapse-free survival rates (all P < 0.001).


The promising results of this study suggest that persistent presence of postoperative CTCs may be a crucial prognostic factor adjuvant to conventional tumor markers in CRC patients who have undergone curative resection. Identification of these high-risk patients of persistent CTCs positivity is important and thus could help to define patients for adjuvant therapy with this tumor entity.


Circulating tumor cells Molecular markers Colorectal cancer Prognosis Postoperative surveillance 



The authors would like to thank Drs. Jan-Sing Hsieh, Deng-Chyang Wu, Yu-Chung Su, Jeng-Yih Wu, and Che-Jen Huang for contributing materially to the paper. This study was supported by a grant from the Chi Mei Medical Center and Kaohsiung Medical University Research Foundation (97CM-KMU-03).


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Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Yih-Huei Uen
    • 1
  • Chien-Yu Lu
    • 2
  • Hsiang-Lin Tsai
    • 3
    • 4
  • Fang-Jung Yu
    • 2
  • Ming-Yii Huang
    • 5
    • 6
  • Tian-Lu Cheng
    • 7
  • Shiu-Ru Lin
    • 8
  • Jaw-Yuan Wang
    • 4
    • 6
  1. 1.Division of General Surgery, Department of SurgeryChi Mei Foundation Medical Center, Taipei Medical UniversityTaipeiTaiwan
  2. 2.Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Department of Emergency MedicineKaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  4. 4.Department of SurgeryKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Department of Radiation OncologyKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
  6. 6.Faculty of Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  7. 7.Faculty of Biomedical Science and Environmental Biology, College of Life ScienceKaohsiung Medical UniversityKaohsiungTaiwan
  8. 8.Department of Medical ResearchFooyin University HospitalKaohsiungTaiwan

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