OBJECTIVES Circulating tumor cells (CTCs) in the blood have been used as diagnostic markers in patients with colorectal cancer (CRC). In this study, we evaluated a CTC detection system based on cell size to assess CTCs and their potential as early diagnostic and prognostic biomarkers for CRC. METHODS From 2014 to 2015, 88 patients with newly diagnosed CRC, who were scheduled for surgery, and 31 healthy volunteers were enrolled and followed up in Pusan National University Hospital. CTCs were enriched using a centrifugal microfluidic system with a new fluid-assisted separation technique (FAST) and detected by cytomorphological evaluation using fluorescence microscopy. RESULTS Two or more CTCs were detected using FAST in 74 patients and 3 healthy volunteers. The number of CTCs in the CRC group was significantly higher than that in the healthy volunteers (P < 0.001). When a receiver operating characteristic curve was created to differentiate patients with CRC from healthy volunteers, the sensitivity and specificity were almost optimized when the critical CTC value was 5/7.5 mL of blood. When this value was used, the sensitivity and specificity in differentiating patients with CRC from the healthy controls were 75% and 100%, respectively. In patients with CRC with ≥5 CTCs, vascular invasion was frequently identified (P = 0.035). All patients with stage IV were positive for CTCs. Patients with ≥5 CTCs showed a trend toward poor overall and progression-free survival. DISCUSSION Our study demonstrated promising results with the use of FAST-based CTC detection for the early diagnosis and prognosis of CRC.

中文翻译：

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大肠癌中循环肿瘤细胞的临床潜力：一项前瞻性研究。

目的血液中的循环肿瘤细胞（CTC）已被用作大肠癌（CRC）患者的诊断标记。在这项研究中，我们评估了基于细胞大小的CTC检测系统，以评估CTC及其作为CRC的早期诊断和预后生物标志物的潜力。方法2014年至2015年，在釜山国立大学医院招募了88例新诊断为CRC的患者并计划进行手术，并招募了31名健康志愿者。使用离心微流体系统和新的流体辅助分离技术（FAST）富集四氯化碳，并使用荧光显微镜通过细胞形态学评估进行检测。结果使用FAST在74位患者和3位健康志愿者中检测到2个或更多CTC。CRC组的CTC数量显着高于健康志愿者（P <0.001）。当创建接收器操作特征曲线以区分CRC患者与健康志愿者时，当临界CTC值为5 / 7.5 mL血液时，灵敏度和特异性几乎达到最佳。使用此值时，区分CRC和健康对照的敏感性和特异性分别为75％和100％。在CTC≥5的CRC患者中，经常发现血管浸润（P = 0.035）。所有IV期患者的CTC阳性。CTC≥5的患者表现出总体生存和无进展生存不良的趋势。