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@ARTICLE{Pouyiourou:286718,
      author       = {M. Pouyiourou$^*$ and T. Bochtler$^*$ and C. Coith and H.
                      Wikman and B. Kraft$^*$ and T. Hielscher$^*$ and A.
                      Stenzinger and S. Riethdorf$^*$ and K. Pantel$^*$ and A.
                      Krämer$^*$},
      title        = {{F}requency and {P}rognostic {V}alue of {C}irculating
                      {T}umor {C}ells in {C}ancer of {U}nknown {P}rimary.},
      journal      = {Clinical chemistry},
      volume       = {70},
      number       = {1},
      issn         = {0009-9147},
      address      = {Oxford},
      publisher    = {Oxford University Press},
      reportid     = {DKFZ-2024-00058},
      pages        = {297 - 306},
      year         = {2024},
      note         = {#EA:A360#LA:A360#},
      abstract     = {Cancer of unknown primary (CUP) is defined as a primary
                      metastatic malignancy, in which the primary tumor remains
                      elusive in spite of a comprehensive diagnostic workup. The
                      frequency and prognostic value of circulating tumor cells
                      (CTCs), which are considered to be the source of metastasis,
                      has not yet been systematically evaluated in CUP.A total of
                      110 patients with a confirmed diagnosis of CUP according to
                      the European Society for Medical Oncology (ESMO) guidelines,
                      who presented to our clinic between July 2021 and May 2023,
                      provided blood samples for CTC quantification using
                      CellSearch methodology. CTC counts were correlated with
                      demographic, clinical, and molecular data generated by
                      comprehensive genomic profiling of tumor tissue.CTCs were
                      detected in $26\%$ of all patients at initial presentation
                      to our department. The highest CTC frequency was observed
                      among patients with unfavorable CUP $(35.5\%),$ while
                      patients with single-site/oligometastatic CUP harbored the
                      lowest CTC frequency $(11.4\%).$ No statistically
                      significant association between CTC positivity and the
                      number of affected organs (P = 0.478) or disease burden (P =
                      0.120) was found. High CTC levels (≥5 CTCs/7.5 mL; 12/95
                      analyzed patients) predicted for adverse overall survival
                      compared to negative or low CTC counts (6-months overall
                      survival rate $90\%$ vs $32\%,$ log-rank P < 0.001; HR 5.43;
                      $95\%$ CI 2.23-13.2). CTC dynamics were also prognostic for
                      overall survival by landmark analysis (log-rank P < 0.001,
                      HR 10.2, $95\%$ CI 1.95-52.9).CTC frequency is a strong,
                      independent predictor of survival in patients with CUP. CTC
                      quantification provides a useful prognostic tool in the
                      management of these patients.},
      keywords     = {Humans / Neoplastic Cells, Circulating / Neoplasms, Unknown
                      Primary: diagnosis / Prognosis / Cost of Illness},
      cin          = {A360 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)A360-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {311 - Zellbiologie und Tumorbiologie (POF4-311)},
      pid          = {G:(DE-HGF)POF4-311},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38175594},
      doi          = {10.1093/clinchem/hvad180},
      url          = {https://inrepo02.dkfz.de/record/286718},
}