Prognostic factor analysis of circulating tumor cells in peripheral blood of patients with peritoneal carcinomatosis of colon cancer origin treated with cytoreductive surgery plus an intraoperative hyperthermic intraperitoneal chemotherapy procedure (CRS + HIPEC)

Surgery. 2016 Mar;159(3):728-35. doi: 10.1016/j.surg.2015.09.013. Epub 2015 Oct 28.


Purpose: Complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed the therapeutic landscape, improving overall survival in patients with peritoneal carcinomatosis with a colonic origin. The main limitation of this aggressive locoregional procedure, however, is extra-abdominal or distant spread. The objective of this study was to identify the prognostic value of circulating tumor cells (CTCs) in patients with peritoneal carcinomatosis of colonic origin undergoing CRS + HIPEC.

Patients and methods: Fourteen patients diagnosed with peritoneal carcinomatosis from colon cancer and suitable for potentially curative treatment with CRS + HIPEC were included in this study. CTCs were isolated from the peripheral blood by immunomagnetic techniques by the use of a multi-cytokeratin-specific antibody and detected via immunocytochemical methods. The phenotypic characterization of EGFR on CTCs was analyzed by immunofluorescence.

Results: At baseline, 50% of the patients were positive for CTCs, with a mean value of 5.5 CTCs per 10 mL of peripheral blood. After surgery, 28.57% of the patients presented CTCs, with a mean value of 6.75 CTCs per 10 mL. A positive correlation was found between the presence of CTC-negative, epidermal growth factor receptor-positive at baseline and the patients who had symptoms of intestinal obstruction (21.4%). In addition, the presence of CTCs identified patients with distant dissemination and was also significantly correlated with progression-free survival (P = .0024).

Conclusion: The detection and characterization of CTCs are good prognostic and predictive markers in patients with peritoneal carcinomatosis resulting from colon cancer. These analyses could be used as a new tool to identify subpopulations of patients who could benefit from CRS + HIPEC treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / blood
  • Carcinoma / mortality
  • Carcinoma / secondary
  • Carcinoma / therapy*
  • Chemotherapy, Cancer, Regional Perfusion / methods*
  • Colonic Neoplasms / pathology*
  • Colonic Neoplasms / surgery
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / methods*
  • Disease-Free Survival
  • Female
  • Humans
  • Hypothermia, Induced / methods
  • Intraoperative Care / methods
  • Male
  • Middle Aged
  • Neoplastic Cells, Circulating / pathology*
  • Peritoneal Neoplasms / blood
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Sampling Studies
  • Survival Analysis
  • Treatment Outcome


  • Biomarkers, Tumor