Clearance of circulating tumor cells after excision of primary colorectal cancer

Objective To establish whether the prevalence of positive reverse transcriptase-polymerase chain reaction (RT-PCR) results decreased during the first 3 months after colorectal cancer excision, and to assess whether persistence of RT-PCR positivity after primary colorectal cancer excision was related to tumor stage or locally advanced and metastatic disease. Methods Systemic venous blood was collected from patients with colorectal cancer before and at intervals up to 12 weeks after surgery. RNA was extracted from the mononuclear cell fraction of the blood samples and subjected to RT-PCR using specific primers for carcinoembryonic antigen mRNA and cytokeratin-20 mRNA. Healthy individuals with no history of cancer were used as controls. Results The results of RT-PCR were positive in 81 of 116 patients with colorectal cancer before surgery, with no significant differences in preoperative prevalence by Dukes stage or presence of locally advanced or metastatic disease. There was a significant decrease in the prevalence of RT-PCR positivity at 24 hours after surgery compared with before surgery. On subgroup analysis by Dukes stage, only the decrease in Dukes A and B patients reached significance. Seven of the 143 controls were RT-PCR positive. Conclusions Circulating tumor cells were present before treatment in most patients with colorectal cancer regardless of tumor stage or metastases. Clearance of circulating tumor cells within 24 hours of colorectal cancer excision was greatest in tumors with the best prognosis.