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Intraoperative Molecular Detection of Circulating Tumor Cells by Reverse Transcription-Polymerase Chain Reaction in Patients With Biliary-Pancreatic Cancer Is Associated With Hematogenous Metastasis

From the First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan.

Correspondence: Address correspondence and reprints to: Sonshin Takao, MD, First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan; Fax: 81-99-265-7426; E-mail: sonshin{at}m2.kufm.kagoshima-u.ac.jp

Background: Circulating tumor cells in the blood were frequently detected by reverse transcription-polymerase chain reaction during operation in patients with biliary-pancreatic cancer. We investigated the relationship between circulating tumor cells during operation and hematogenous metastases.

Methods: Blood samples from 67 patients with biliary-pancreatic cancer were obtained from the portal vein, peripheral artery, and superior vena cava during operation. After total RNA was extracted from each blood sample, carcinoembryonic antigen (CEA)–specific reverse transcription-polymerase chain reaction was performed.

Results: Intraoperative CEA-messenger RNA (mRNA) expression was detected in the blood of 32 (47.8%) of 67 patients with biliary-pancreatic cancer, although it was not detected in the blood obtained from 20 healthy volunteers or 15 patients with benign disease of the biliary pancreas. The incidence (37.5%) of hematogenous metastases after surgery in the CEA-mRNA–positive group (n = 32) was significantly higher than that (11.4%) in the negative group (n = 35; P = .01). In stage I, II, and III patients, survival of the CEA-mRNA–positive group was significantly worse compared with that of negative group (P = .03).

Conclusions: Intraoperative molecular detection of circulating tumor cells in patients with biliary-pancreatic cancer relates to a high risk of hematogenous metastasis and is associated with unfavorable prognosis even after curative resection.

Key Words: CEA-mRNA • RT-PCR • Circulating tumor cells • Hematogenous metastasis • Liver metastasis • Biliary-pancreatic cancer

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