Circulating Tumor Cells Expressing Krüppel-Like Factor 8 and Vimentin as Predictors of Poor Prognosis in Pancreatic Cancer Patients.

Background: Circulating tumor cells (CTCs) with an epithelial-mesenchymal transition phenotype in peripheral blood may be a useful marker of carcinomas with poor prognosis. The aim of this study was to determine the prognostic significance of CTCs expressing Krüppel-like factor 8 (KLF8) and vimentin in pancreatic cancer (PC).

Methods: CTCs were isolated by immunomagnetic separation from the peripheral blood of 40 PC patients before undergoing surgical resection. Immunocytochemistry was performed to identify KLF8 and vimentin CTCs. The associations between CTCs and time to recurrence (TTR), clinicopathologic factors, and survival were assessed. Univariate and multivariate analyzes were performed to identify risk factors.

Results: Patients with CTCs ( = 30) had a higher relapse rate compared to those without ( = 10) (70.0% 20.0%; < 0.01). The proportion of KLF8/vimentin CTCs to total CTCs was inversely related to TTR ( = -0.646; < 0.01); TTR was reduced in patients with > 50% of CTCs identified as KLF8/vimentin ( < 0.01). Independent risk factors for recurrence were perineural invasion and > 50% KLF8/vimentin CTCs (both < 0.05).

Conclusion: Poor prognosis can be predicted in PC patients when > 50% of CTCs are positive for KLF8 and vimentin.