Preoperative circulating tumor cells as a prognostic indicator in gastric cancer

Abstract

BACKGROUND

Circulating tumor cells (CTCs) are promising minimally invasive biomarkers for tumor biology and metastasis. Although their clinical value has been established in several cancers, the evidence supporting their role in gastric cancer remains inconsistent and warrants further validation.

AIM

To investigate the prognostic value of preoperative CTCs detection in patients with gastric cancer.

METHODS

A retrospective analysis of patients with pathologically confirmed gastric adenocarcinoma who underwent preoperative testing of peripheral blood CTCs at the Department of Gastric and Small Intestinal Surgery, Zhangzhou Hospital, Fujian Province between June 2020 and March 2021 was performed. Correlations between preoperative CTCs status and clinicopathological characteristics as well as prognosis were evaluated.

RESULTS

Among the 115 patients newly diagnosed with gastric cancer, 61 (53.04%) were CTCs-positive and 54 (46.96%) were CTCs-negative. Significant differences were observed between the CTCs-positive and CTCs-negative groups in terms of tumor differentiation, lymph node metastasis, distant metastasis, pathologic tumour, node, and metastasis stage, and coagulation parameters (activated partial thromboplastin time, thrombin time, D-dimer level, and platelet count) (all P < 0.05). However, no significant differences were found in age, sex, body mass index, tumor size, tumor location, depth of invasion, neural invasion, vascular invasion, or other coagulation markers (prothrombin time and fibrinogen) (all P > 0.05). Univariate Cox regression analysis identified tumor size, depth of invasion, lymph node and distant metastases, tumor stage, neural invasion, vascular invasion, and CTCs positivity as risk factors for poor prognosis in patients with gastric cancer. At the follow-up cutoff date, recurrence or metastasis had occurred in 28 CTCs-positive patients (45.90%) and 15 CTCs-negative patients (27.78%). The CTCs-positive group exhibited higher rates of distant metastasis (78.57% vs 66.67%, P = 0.394) and peritoneal metastasis (64.29% vs 46.67%, P = 0.264) than the CTCs-negative group. Additionally, the CTCs-positive group had significantly shorter progression-free survival (PFS) (32.72 months vs 39.96 months, P = 0.036) and a trend toward reduced overall survival (38.62 months vs 41.11 months, P = 0.411).

CONCLUSION

Preoperative CTCs detection is associated with aggressive biological behavior in gastric cancer and has predictive value for PFS. Based on these findings, we recommend integrating preoperative CTCs testing into the clinical management of patients to improve risk stratification and guide personalized treatment strategies. Further prospective studies are warranted to validate the utility of optimizing surveillance protocols and therapeutic decisions.

Keywords: Gastric cancer; Circulating tumor cells; Clinicopathological characteristics; Survival; Risk stratification

Core Tip: This study demonstrates that preoperative detection of circulating tumor cells (CTCs) is a potent and minimally invasive prognostic tool for gastric cancer. We found that CTCs-positive status was significantly associated with aggressive clinicopathological features, including advanced tumor stage and metastasis. Importantly, CTCs positivity was an independent predictor of significantly shorter progression-free survival. These findings strongly support the integration of preoperative CTCs testing into standard clinical practice to enhance risk stratification and guide personalized treatment decisions for patients with gastric cancer.