Circulating tumor cells in ovarian cancer patients as a cellular marker for early detection of ovarian cancer in asymptomatic patients

Abstract Purpose Ovarian cancer (OC) is the leading cause of death among gynecologic cancers worldwide. The aim of this study was to identify and enumerate circulating tumor cells (CTCs) in OC patients and correlate their numbers with the clinical outcomes. Methods we enrolled patients diagnosed with suspected OC based on history, ultrasound criteria, and tumor markers. Complete clinical examination, abdominal and pelvic ultrasonography, serum CA125, and risk of malignancy index (RMI) were recorded. The percentage of CTCs was analyzed using flow cytometry based on the following phenotypes CD105+, CD24+, CD117+, and Epcam+. Results CTCs were found in 100% of patients with primary OC and no CTCs were found in secondary or borderline OC. The mean of CTC numbers in all patients was 0.12 ± 0.11 cells/µl. The highest number of CTCs was observed among the malignant patients; A highly statistically significant (p-value < 0.001) positive correlation (r = 0.55) was found between CTCs and FIGO, between CTCs and RMI (r = 0.53; p-value < 0.001), and CTCs and CA-125 (r = 0.42; p-value < 0.001). The CTCs count allowed to distinguish between early and late FIGO stage at a cutoff level of > 0.82 cells/µl, with 66.7% sensitivity, 90.9% specificity, 88% PPV and 73.2% NPV (AUC = 0.65 & p-value = 0.076). Conclusion CTCs can be used as a cellular marker for the early detection of OC.