Circulating Tumor Cell Kinetics and Morphology from the Liquid Biopsy Predict Disease Progression in Patients with Metastatic Colorectal Cancer Following Resection

Simple Summary As a minimally invasive procedure, the liquid biopsy enables the longitudinal evaluation of a patient's disease and response to treatment. Current clinical practice stratifies patient status based on a uniform threshold for circulating tumor cell (CTC) positivity, overlooking various cell subtypes and timepoints of sample collection. In a disease known for its tumor heterogeneity, we investigated colorectal cancer patients' peripheral blood samples to determine whether the prevalence of morphologically distinct CTC subtypes and time-points of sample collection correlate with clinical disease hallmarks and survival data. Our results highlight nuances between the CTC subtypes' clinical and survival significance. Furthermore, we found that time-point-conscious cell enumeration is critical, both for determining CTC positivity and the change in cell populations over time. To improve its clinical utility moving forward, we suggest that liquid biopsy analysis integrates morphology and time-based analysis alongside standard CTC enumeration at various stages of a patient's treatment. The liquid biopsy has the potential to improve current clinical practice in oncology by providing real-time personalized information about a patient's disease status and response to treatment. In this study, we evaluated 161 peripheral blood (PB) samples that were collected around surgical resection from 47 metastatic colorectal cancer (mCRC) patients using the High-Definition Single Cell Assay (HDSCA) workflow. In conjunction with the standard circulating tumor cell (CTC) enumeration, cellular morphology and kinetics between time-points of collection were considered in the survival analysis. CTCs, CTC-Apoptotic, and CTC clusters were found to indicate poor survival with an increase in cell count from pre-resection to post-resection. This study demonstrates that CTC subcategorization based on morphological differences leads to nuanced results between the subtypes, emphasizing the heterogeneity within the CTC classification. Furthermore, we show that factoring in the time-point of each blood collection is critical, both for its static enumeration and for the change in cell populations between draws. By integrating morphology and time-based analysis alongside standard CTC enumeration, liquid biopsy platforms can provide greater insight into the pathophysiology of mCRC by highlighting the complexity of the disease across a patient's treatment.