Circulating tumor cells, tumor-derived extracellular vesicles and plasma cytokeratins in castration-resistant prostate cancer patients

Afroditi Nanou* (Corresponding Author), Frank A.W. Coumans, Guus van Dalum, Leonie L. Zeune, David Dolling, Wendy Onstenk, Mateus Crespo, Mariane Sousa Fontes, Pasquale Rescigno, Gemma Fowler, Penny Flohr, Christoph Brune, Stefan Sleijfer, Johann S. de Bono, Leon W.M.M. Terstappen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Purpose: The presence of Circulating Tumor Cells (CTCs) in Castration-Resistant Prostate Cancer (CRPC) patients is associated with poor prognosis. In this study, we evaluated the association of clinical outcome in 129 CRPC patients with CTCs, tumor-derived Extracellular Vesicles (tdEVs) and plasma levels of total (CK18) and caspase-cleaved cytokeratin 18 (ccCK18).

Experimental Design: CTCs and tdEVs were isolated with the CellSearch system and automatically enumerated. Cut-off values dichotomizing patients into favorable and unfavorable groups of overall survival were set on a retrospective data set of 84 patients and validated on a prospective data set of 45 patients. Plasma levels of CK18 and ccCK18 were assessed by ELISAs.

Results: CTCs, tdEVs and both cytokeratin plasma levels were significantly increased in CRPC patients compared to healthy donors (HDs). All biomarkers except for ccCK18 were prognostic showing a decreased median overall survival for the unfavorable groups of 9.2 vs 21.1, 8.1 vs 23.0 and 10.0 vs 21.5 months respectively. In multivariable Cox regression analysis, tdEVs remained significant.

Conclusions: Automated CTC and tdEV enumeration allows fast and reliable scoring eliminating inter- and intra- operator variability. tdEVs provide similar prognostic information to CTC counts.

Original languageEnglish
Pages (from-to)19283-19293
Number of pages11
Issue number27
Publication statusPublished - 10 Apr 2018


  • Castration-resistant prostate cancer (CRPC)
  • Circulating tumor cells (CTCs)
  • Cytokeratin 18 (CK18)
  • Tumor-derived Extracellular Vesicles (tdEVs)
  • Caspase-cleaved cytokeratin 18 (ccCK18)

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