Circulating tumor cells detection by liquid biopsy during early-stage cervical cancer surgery: a preliminary feasibility study

The recurrence of early-stage cervical carcinoma (CC) (about 10%) might be due to disseminated tumor cells. This pilot study aimed to assess the feasibility of detecting perioperative CTCs in peripheral blood during surgery for early-stage CC and to explore intraoperative CTC dynamics. In this bicentric prospective study, 11 patients undergoing laparoscopic resection of histologically confirmed FIGO stage IA1 to IB2 CC were included. CTCs were enumerated using the CellSearch ® system in peripheral blood samples collected (i) preoperatively (T0), (ii) after pneumoperitoneum creation (T1), and (iii) before colpotomy (T2). The primary outcome was perioperative CTC detection (T1 or T2) and secondary outcomes included recurrence-free survival. CTCs were detected only peroperatively in 3/11 patients (27.3%; 95% CI: 7.3–60.7). One patient (9.1%) had 2 CTCs detected at T1 and two patients (18.2%) had CTCs detected at T2 (50 and 2 CTCs respectively). Among patients with CTCs, two had an epidermoid carcinoma and one an adenocarcinoma; they had stage IA1, IA2, and IB1 respectively. Histopathological examination of hysterectomy specimens revealed residual tumor in 6/11 patients (54.5%), including one CTC-positive patient. After a median follow-up of 34 months, one recurrence (9.1%) occurred, in a patient without perioperative CTC detection. This pilot study demonstrates the feasibility of perioperative CTC detection in peripheral blood during surgery for early-stage CC and provides preliminary data regarding intraoperative CTC dynamics. Given the small sample size and limited number of clinical events, no conclusions can be drawn regarding the prognostic or therapeutic value of perioperative CTC detection. These preliminary findings warrant validation in larger prospective cohorts. ClinicalTrials.gov, NCT04770090, registered on 25 february 2021.