Selective Hepatic Vein Sampling for Enriched Circulating Tumor Cell Collection in Patients with Liver Dominant Malignancy—Preliminary Results

Wednesday, March 8, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 225AB

Abstract Speaker(s)

James Z. Hui, MD, PhD

Resident
Interventional Radiology, Stanford University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

YZ

Yili Zhu, PhD

Postdoctoral scholar
Pathology, Stanford University
DS

Daniel Y. Sze, MD, PhD (he/him/his)

Professor, Editor in Chief
Stanford University; Journal of Vascular and Interventional Radiology
AL

Alarice Lowe, MD

Associate Professor
Pathology, Stanford University
David S. Wang, MD, FSIR

Clinical Associate Professor
Interventional Radiology, Stanford University

Disclosure(s):

James Z. Hui, MD, PhD: No financial relationships to disclose

Daniel Y. Sze, MD, PhD: Artio Medical: Consultant (Terminated, January 1, 2021); Astra Zeneca: Consultant (Terminated, January 1, 2021); Bayer: Consultant (Terminated, January 1, 2021); BlackSwan Vascular: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Boston Scientific / Biocompatibles BTG: Consultant (Terminated, January 1, 2021), Contracted Research (Terminated, January 1, 2021); Bristol Myers Squibb: Consultant (Terminated, January 1, 2021); Eisai: Consultant (Terminated, January 1, 2021); FluidX: Consultant (Terminated, January 1, 2021); Guerbet: Consultant (Terminated, January 1, 2021); Koli Medical, Inc.: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); RadiAction Medical: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Sirtex Medical: Consultant (Terminated, January 1, 2021), Contracted Research (Terminated, January 1, 2021); Terumo: Consultant (Terminated, January 1, 2021); Trisalus Life Sciences: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Varian: Consultant (Terminated, January 1, 2021); W. L. Gore: Consultant (Terminated, January 1, 2021)

Purpose: Circulating tumor cells (CTCs) are cancer cells that are shed by primary tumors into circulatory pathways and are the causative agents of metastasis. The detection and characterization of CTCs can provide prognostic information and insights into tumor biology and the metastatic process. CTCs are typically collected from peripheral veins (‘liquid’ biopsies), with low yields ( < 3 cells/7mL tube) due to CTC filtration by capillary beds and blood volume dilution. The purpose of this study was to determine whether selective sampling of the hepatic veins which directly drain intrahepatic tumors results in collection of more CTCs compared to peripheral vein sampling.

Materials and Methods: Under an IRB approved protocol, venous blood samples were collected via a catheter placed into the main hepatic vein draining intrahepatic tumors and via a peripheral vein in 5 GI cancer patients with liver dominant metastases or primary liver cancer during their standard of care chest port placement procedures. The samples were processed and analyzed for the presence of CTCs (EPCAM+, CK+, CD45-) using a high-throughput immunofluorescent imaging platform (Rarecyte CyteFinder II). For each patient, CTC counts were compared between the hepatic vein and peripheral vein samples.

Results:

In all patients, CTCs were enriched in the hepatic vein samples compared to the peripheral vein samples, ranging from 1.9-fold to >1000-fold (Table). In the patient with lowest CTC enrichment, there was a general paucity of EPCAM+/CK+/CD45- CTCs despite extensive disease burden, but instead an abundance of EPCAM-/CK+/CD45- cells, which may suggest the presence of CTCs with atypical surface makers in subsets of patients, as has been previously reported.*

Conclusion: Selective hepatic vein sampling using routine IR techniques can increase the yield of CTCs for clinical and basic science research into GI malignancies. This may allow IRs to contribute to the development of better prognostic biomarkers, detect micro-metastases, and advance research on the biology of metastasis.