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Circulating tumor cells (CTCs) in blood have been studied as predictors of recurrence and the prognosis of various solid cancers. Circulating tumor stem cells (CTSCs) are involved in the metastatic recurrence of cancer however, no clinical finding regarding CTSCs is present in the literature. The aim of the study was to determine the potential of CTC and CTSC measurements as biomarkers for colorectal cancer. Methods: This is prospective single-center observational study. We included 120 patients with colorectal cancer between November 2008 and 2014 in this study. CTCs and CTSCs were isolated via immunomagnetic separation and stained with fluorescently labeled monoclonal antibodies; their levels were then measured. Results: CTCs were detected in 45 of 120 patients. In patients with Stage IV cancer, 14.8% (12/81) were positive and they had a significantly worse outcome (P = 0.00021). In addition, CTCs were measured in specimens obtained during apheresis from six patients with Stage IV cancer even though all six patients were positive for CTCs. Furthermore, the prognosis of patients with mCRC who tested positive for CD133 or CD44 as well as for CTSCs was significantly poorer than for the 14 subjects with mCRC who did not test positive for CD133 or CD44 (p = 0.0183). Conclusion: The potential of CTCs as a biomarker was negligible in patients with Stage I–III cancer. CTCs appeared to be potential biomarkers for poor prognosis in patients with Stage IV cancer. Therefore, the presence of CTSC in metastatic colorectal cancer cases can be considered as a biomarker for poor prognosis.

Circulating Tumor Stem Cells and Circulating Tumor Cells are Prognostic Biomarkers for Patients with Metastatic Colorectal Cancer