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Hao YJ, Chang LW, Yang CY, Lo LC, Lin CP, Jian YW, Jiang JK, Tseng FG. The rare circulating tumor microemboli as a biomarker contributes to predicting early colorectal cancer recurrences after medical treatment. Transl Res 2024; 263:1-14. [PMID: 37558203 DOI: 10.1016/j.trsl.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
Early prognosis of cancer recurrence remains difficult partially due to insufficient and ineffective screening biomarkers or regimes. This study evaluated the rare circulating tumor microemboli (CTM) from liquid biopsy individually and together with circulating tumor cells (CTCs) and serum CEA/CA19-9 in a panel, on early prediction of colorectal cancer (CRC) recurrence. Stained CTCs/CTM were detected by a microfluidic chip-based automatic rare-cell imaging platform. ROC, AUC, Kaplan-Meier survival, and Cox proportional hazard models regarding 4 selected biomarkers were analyzed. The relative risk, odds ratio, predictive accuracy, and positive/negative predictive value of biomarkers individually and in combination, to predict CRC recurrence were assessed and preliminarily validated. The EpCAM+Hochest+CD45- CTCs/CTM could be found in all cancer stages, where more recurrences were observed in late-stage cases. Significant correlations between CTCs/CTM with metastatic stages and clinical treatment were illustrated. CA19-9 and CTM could be seen as independent risk factors in patient survivals, while stratified patients by grouped biomarkers on the Kaplan-Meier analyses presented more significant differences in predicting CRC recurrences. By monitoring the panel of selected biomarkers, disease progressions of 4 CRC patients during follow-up visits after first treatments within 3 years were predicted successfully. This study unveiled the value of rare CTM on clinical studies and a panel of selected biomarkers on predicting CRC recurrences in patients at the early time after medical treatment, in which the CTM and serum CA19-9 could be applied in clinical surveillance and CRC management to improve the accuracy.
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Affiliation(s)
- Yun-Jie Hao
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Lu-Wey Chang
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Yung Yang
- Department of Teaching and Research, Taipei City Hospital, Taipei, Taiwan; Commission for General Education, National United University, Miaoli, Taiwan; General Education Center, University of Taipei, Taipei, Taiwan
| | - Liang-Chuan Lo
- National Genomics Center for Clinical and Biotechnological Applications, Cancer and Immunology Research Center, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chien-Ping Lin
- Department of Surgery, Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Wei Jian
- Department of Surgery, Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Department of Surgery, Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Gang Tseng
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan; Department of Chemistry, Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing-Hua University, Hsinchu, Taiwan; Research Center for Applied Sciences, Taipei, Taiwan.
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Chu HY, Yang CY, Yeh PH, Hsu CJ, Chang LW, Chan WJ, Lin CP, Lyu YY, Wu WC, Lee CW, Wu JK, Jiang JK, Tseng FG. Highly Correlated Recurrence Prognosis in Patients with Metastatic Colorectal Cancer by Synergistic Consideration of Circulating Tumor Cells/Microemboli and Tumor Markers CEA/CA19-9. Cells 2021; 10:1149. [PMID: 34068719 PMCID: PMC8151024 DOI: 10.3390/cells10051149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
Circulation tumor cells (CTCs) play an important role in metastasis and highly correlate with cancer progression; thus, CTCs could be considered as a powerful diagnosis tool. Our previous studies showed that the number of CTCs could be utilized for recurrence prediction in colorectal cancer (CRC); however, the odds ratio was still lower than five. To improve prognosis in CRC patients, we analyzed CTC clusters/microemboli, CTC numbers, and carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) levels using a self-assembled cell array (SACA) chip system for recurrence prediction. In CRC patients, the presence of CTC clusters/microemboli may have higher correlation in metastasis when compared to the high number of CTCs. Additionally, when both the number of CTCs and serum CEA levels are high, very high odds ratios of 24.4 and 17.1 are observed in patients at all stages and stage III of CRC, respectively. The high number of CTCs and CTC clusters/microemboli simultaneously suggests the high chance of relapse (odds ratio 8.4). Overall, the characteristic of CTC clusters/microemboli, CEA level, and CTC number have a clinical potential to enhance CRC prognosis.
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Affiliation(s)
- Hsueh-Yao Chu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Yung Yang
- Department Education Research, Taipei City Hospital, Taipei 10341, Taiwan;
- Center for General Education, National United University, Miaoli 36003, Taiwan
- General Education Center, University of Taipei, Taipei 110014, Taiwan
| | - Ping-Hao Yeh
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
| | - Chun-Jieh Hsu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
| | - Lu-Wei Chang
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
| | - Wei-Jen Chan
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
| | - Chien-Ping Lin
- Institute of Microbiology and Immunology, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (C.-P.L.); (Y.-Y.L.)
| | - You-You Lyu
- Institute of Microbiology and Immunology, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (C.-P.L.); (Y.-Y.L.)
| | - Wei-Cheng Wu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
- Nano Science and Technology Program, Taiwan International Graduate Program, Academia Sinica, Taipei 115, Taiwan
| | - Chun-Wei Lee
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
| | - Jen-Kuei Wu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
- Biomedical Science and Engineering Center, National Tsing Hua University, No. 101, Sec. 2, Kuang-Fu Rd., Hsinchu 30013, Taiwan
| | - Jeng-Kai Jiang
- Department of Surgery, Division of Colorectal Surgery, Taipei Veterans General Hospital, Taiwan School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Fan-Gang Tseng
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (H.-Y.C.); (P.-H.Y.); (C.-J.H.); (L.-W.C.); (W.-J.C.); (W.-C.W.); (C.-W.L.); (J.-K.W.)
- Nano Science and Technology Program, Taiwan International Graduate Program, Academia Sinica, Taipei 115, Taiwan
- Department of Engineering and System Science, Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing-Hua University, Hsinchu 30013, Taiwan
- Research Center for Applied Sciences, Academia Sinica, No. 128, Sec. 2, Academia Rd., Nankang, Taipei 11529, Taiwan
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Enumerating Circulating Tumor Cells with a Self-Assembled Cell Array (SACA) Chip: A Feasibility Study in Patients with Colorectal Cancer. Cancers (Basel) 2019; 11:cancers11010056. [PMID: 30626171 PMCID: PMC6356678 DOI: 10.3390/cancers11010056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/01/2019] [Accepted: 01/03/2019] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer-related death worldwide. Detecting and enumerating circulating tumor cells (CTCs) in patients with colorectal cancer emerged as an important prognostic tool which provides a direct estimate of metastatic potential. Improving the turnaround time and decreasing sample volume is critical for incorporating this liquid biopsy tool into routine practice. The objective of the current study was to validate the clinical feasibility of a self-assembled cell array (SACA) chip, a CTC counting platform with less than 4 h turnaround time, in patients with newly diagnosed colorectal cancers. In total, 179 patients with newly diagnosed colorectal cancers from a single institute were enrolled. Epithelial cell adhesion molecule positive (EpCAM(+)), cluster of differentiation 45 negative (CD45(-)) cells were isolated and enumerated from 2 mL of peripheral vein blood (PB) and inferior mesenteric vein blood (IMV) samples obtained during surgery. We found that the CTC count in PB but not IMV correlates with disease stages. Neoadjuvant chemotherapy did not lead to decreased CTC count in both types of blood samples. With cutoffs of four CTCs per 2 mL of blood, and serum carcinoembryonic antigen (CEA) level of 5 ng/mL, patients with non-metastatic disease were more likely to experience recurrence if they had high PB CTC count and high serum CEA concentration (odds ratio, 8.9). Our study demonstrates the feasibility of enumerating CTCs with a SACA chip in patients with colorectal cancer.
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Chen X, Wo F, Chen J, Tan J, Wang T, Liang X, Wu J. Ratiometric Mass Spectrometry for Cell Identification and Quantitation Using Intracellular "Dual-Biomarkers". Sci Rep 2017; 7:17432. [PMID: 29234137 PMCID: PMC5727126 DOI: 10.1038/s41598-017-17812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/01/2017] [Indexed: 12/27/2022] Open
Abstract
This study proposed an easy-to-use method for cell identification and quantitation by ratiometric matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Two pairs of MS peaks in the molecular fingerprint of cells were selected as intracellular dual-biomarkers due to the stability and specificity of their ratio values in different types of hepatocellular cancer (HCC) cell lines. Five types of HCC cells can be thereafter differentiated based on these two pairs of intracellular peptides/proteins. Two types of HCC cells, Huh7 and LM3 were co-cultured as a model to test whether the method is feasible for cell quantitation. The results indicated that the ratiometric peak intensity of the two pair biomarkers exhibits linear relationship with the proportion of Huh7 cells. Furthermore, tumor heterogeneity was simulated by subcutaneously injecting the co-cultured cells into nude mice. The cell type and proportion in the section of grown tumor tissue can be discriminated using the ratiometric MALDI imaging approach. LC-MS/MS detection revealed that one of the biomarker pairs belongs to thymosin family, β4 and β10. The ratiometric MS spectral approach using intracellular dual-biomarkers might become a pervasive strategy for high-throughput cell identification and quantitation, which is vital in tumor heterogeneity study, clinical diagnosis and drug screening.
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Affiliation(s)
- Xiaoming Chen
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou, 310058, China
| | - Fangjie Wo
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou, 310058, China
| | - Jiang Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jie Tan
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou, 310058, China
| | - Tao Wang
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou, 310058, China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
| | - Jianmin Wu
- Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou, 310058, China.
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Chen TJ, Wu JK, Chang YC, Fu CY, Wang TP, Lin CY, Chang HY, Chieng CC, Tzeng CY, Tseng FG. High-efficiency rare cell identification on a high-density self-assembled cell arrangement chip. BIOMICROFLUIDICS 2014; 8:036501. [PMID: 24926391 PMCID: PMC4032428 DOI: 10.1063/1.4874716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/23/2014] [Indexed: 05/17/2023]
Abstract
Detection of individual target cells among a large amount of blood cells is a major challenge in clinical diagnosis and laboratory protocols. Many researches show that two dimensional cells array technology can be incorporated into routine laboratory procedures for continuously and quantitatively measuring the dynamic behaviours of large number of living cells in parallel, while allowing other manipulations such as staining, rinsing, and even retrieval of targeted cells. In this study, we present a high-density cell self-assembly technology capable of quickly spreading over 300 000 cells to form a dense mono- to triple-layer cell arrangement in 5 min with minimal stacking of cells by the gentle incorporation of gravity and peripheral micro flow. With this self-assembled cell arrangement (SACA) chip technology, common fluorescent microscopy and immunofluorescence can be utilized for detecting and analyzing target cells after immuno-staining. Validated by experiments with real human peripheral blood samples, the SACA chip is suitable for detecting rare cells in blood samples with a ratio lower than 1/100 000. The identified cells can be isolated and further cultured in-situ on a chip for follow-on research and analysis. Furthermore, this technology does not require external mechanical devices, such as pump and valves, which simplifies operation and reduces system complexity and cost. The SACA chip offers a high-efficient, economical, yet simple scheme for identification and analysis of rare cells. Therefore, potentially SACA chip may provide a feasible and economical platform for rare cell detection in the clinic.
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Affiliation(s)
- Tsung-Ju Chen
- Institute of NanoEngineering and MicroSystems, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Jen-Kuei Wu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Yu-Cheng Chang
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Chien-Yu Fu
- Institute of Molecular Medicine, National Tsing Hua University, Kuang-Fu Road, Hsinchu 30013, Taiwan
| | - Tsung-Pao Wang
- Institute of Molecular Medicine, National Tsing Hua University, Kuang-Fu Road, Hsinchu 30013, Taiwan
| | - Chun-Yen Lin
- Institute of Molecular Medicine, National Tsing Hua University, Kuang-Fu Road, Hsinchu 30013, Taiwan
| | - Hwan-You Chang
- Institute of Molecular Medicine, National Tsing Hua University, Kuang-Fu Road, Hsinchu 30013, Taiwan
| | - Ching-Chang Chieng
- Department of Mechanical and Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fan-Gang Tseng
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 30013, Taiwan ; Academia Sinica, National Tsing Hua University, Taipei 115, Taiwan
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