Many studies evaluating circulating tumor cells have been published during the past decade. In a variety of tumor types, a correlation between the incidence of blood-borne cells and tumor stage has been demonstrated.4,32,40,52,53 Unfortunately, the data do not support the reverse approach. At present, it does not appear possible to utilize molecular means to more accurately stage a patient.33 Ultimately, the presence of circulating tumor cells may provide valuable information on the systemic spread of tumor in a manner different from conventional staging approaches. In prostate cancer, small but aggressive tumors may shed cells into the circulation while a more indolent but larger tumor may not; such a situation may appear to correlate poorly with tumor stage but may more accurately reflect tumor aggressiveness. The detection of circulating breast cancer cells has been correlated with vascular invasion in the primary tumor. Larger studies using appropriate markers are needed to determine how to integrate these molecular test results into cancer staging strategies.
While a relationship between circulating tumor cells and tumor stage is evident, few studies have demonstrated a correlation between circulating cells and cancer recurrence or progression. Such studies require lengthy patient follow-up. Recently, however, a correlation between blood-borne cells and disease-free survival following radical prostatectomy has been reported.35
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