Z Gastroenterol 2025; 63(08): e539-e540
DOI: 10.1055/s-0045-1810952
Abstracts | DGVS/DGAV
Kurzvorträge
Molekulare Mechanismen bei Pankreaskarzinom Donnerstag, 18. September 2025, 15:50 – 17:18, Seminarraum 6 + 7

Transitional type circulating tumor cells predict systemic recurrence and benefit of adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: long-term outcomes of the CLUSTER trial

I F Rompen
1   Universitätsklinikum Heidelberg, Departement für Allgemein, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland
,
J R Habib
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
A Marchetti
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
E Sereni
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
J He
3   Johns Hopkins, Department of Surgery, Baltimore, Vereinigte Staaten
,
B Hewitt
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
G Sacks
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
K Morgan
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
A Javed
2   New York University, Department of Surgery, New York, Vereinigte Staaten
,
C L Wolfgang
2   New York University, Department of Surgery, New York, Vereinigte Staaten
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Aim: To evaluate the role of transitional circulating tumor cells (trCTCs) in predicting systemic recurrence and survival benefit from adjuvant chemotherapy.

Background: The high metastatic potential of pancreatic cancer (PDAC) is presumed to be associated with early dissemination after cancer cell reprogramming via an epithelial-to-mesenchymal transition. These cells are detectable in circulation as trCTCs and could serve as valuable biomarker capturing systemic disease involvement.

Methods: The prospective CLUSTER trial enrolled patients planned for PDAC resection (2016-2018). CTCs were isolated pre- and postoperatively using the Isolation by SizE of Tumor Cells device and characterized by immunofluorescence. Cox-regression models with spline terms were used to estimate non-linear associations between preoperative serologic biomarkers and systemic recurrence. Additionally, multivariable cox-subgroup analyses with interaction tests were performed to assess overall survival differences associated with adjuvant chemotherapy.

Results: In preoperative samples, trCTCs were detected in 82 (67%) of 123 patients with a median number of two cells per ml (IQR 1-3). A linear association of preoperative trCTC-counts with systemic recurrence (χ²=13.2, p=0.004, [Fig. 1] and [2]) was observed. Furthermore, there was an associated treatment benefit of adjuvant treatment only in trCTC positive patients after resection (N=31, 0.21, 95%CI: 0.09-0.49) whereas there was no associated benefit for trCTC negative patients (HR 1.62, 95%CI: 0.51-5.16) after adjustment for tumor stage and neoadjuvant chemotherapy ([Fig. 3]).

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Fig. 1  
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Fig. 2  
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Fig. 3  

Conclusions: Preoperatively, increase of trCTC count is associated with a strong increase in risk for systemic recurrence. Furthermore, we could confirm that postoperative presence of trCTC represents minimal residual disease and that these patients benefit from adjuvant chemotherapy. The integration of trCTC into the clinical pathway for patients with PDAC could enhance risk stratification and enable more personalized treatment decisions.



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Artikel online veröffentlicht:
04. September 2025

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