Perioperative circulating tumor cells (CTCs) and CTC-white blood cells detected by a size-based platform predict worse prognosis in renal cell cancer patients

Abstract Purpose To explore the clinical significance of perioperative CTCs counts, EMT-CTCs and CTC- white blood cells (WBCs) in renal cancer patients.Materials and Methods A total of 131 patients with renal cancer who underwent operation from the Second Affiliated Hospital of Xi’an Jiaotong University were enrolled. 20 patients with benign renal diseases were used as control. 5 mL Peripheral blood was extracted from 131 patients with renal cancer before operation and about 3 months after operation. Control patients took blood at the corresponding time. CanPatrol CTC detection technique was used to enrich and identify CTCs, EMT-CTCs and CTC-WBCs simultaneously.Results All patients enrolled were T1-3N0M0. 52 renal cancer patients received radical resection, while other 79 patients underwent nephron-sparing surgery. The positive rate of CTC, mesenchymal CTCs (MCTC) and CTC-WBC before surgery were 95.4% (125/131), 61.1% (80/131) and 11.5% (15/131), respectively. Preoperative total CTCs, mesenchymal CTCs or CTC-WBCs were poorly correlated with patients’ parameters. Preoperative CTC, MCTC or CTC-WBC showed little association with progression-free survival (PFS), while post-operation total CTC (≥ 6), positive mesenchymal CTCs and positive CTC-WBC significantly correlated with early recurrence and metastasis, and remained independent indicators for worse PFS. In addition, the elevation of CTC and MCTC after operation were also correlated with unfavourable PFS.Conclusions With the detection of CTCs in peripheral blood, better risk stratification of renal cancer patients might therefore help to identify a subset of patients that might have higher recurrent risk than the overall population of patients.