Cancer Genetics and Epigenetics 2024, Vol.12, No.5, 254-269 http://medscipublisher.com/index.php/cge 260 Figure 2 Detection and separation technology of CTCs. 5.2 Prognostic significance of CTC count and characteristics The prognostic value of CTCs in colorectal cancer has been extensively studied. A meta-analysis revealed that the presence of CTCs is significantly associated with poor overall survival and disease progression in CRC patients. Specifically, patients with detectable CTCs had a higher hazard ratio for mortality and disease progression, underscoring the prognostic significance of CTC counts (Tan and Wu, 2017). Additionally, the enumeration of CTCs has been correlated with neoplasm progression and distant metastasis in non-metastatic CRC patients, indicating that higher CTC counts are predictive of early recurrence and metastasis (Tsai et al., 2016). Although correlations between CTC enumeration and survival rates have been established, determining optimal cutoff values remains a challenge. In colorectal cancer (CRC), retrospective studies have associated having more than three CTCs with overall survival (OS) and progression-free survival (PFS)（Kahounová et al,2023). CTCs undergoing epithelial-mesenchymal transition (EMT) have also been identified as a prognostic marker. These cells, characterized by specific molecular markers, are associated with early recurrence and metastasis, providing further prognostic insights (Qi et al., 2018). The clinical relevance of CTCs as prognostic markers is further supported by their correlation with TNM staging and other pathological features in CRC patients (Pan et al., 2021). 5.3 Molecular profiling of CTCs Molecular profiling of CTCs involves analyzing their genetic and phenotypic characteristics to understand their role in cancer metastasis and to identify potential therapeutic targets. Recent advancements in technology have enabled the precise isolation and characterization of CTCs, revealing their heterogeneity and the presence of specific markers associated with metastatic potential. For example, CTCs expressing cancer stem cell (CSC) markers such as DCLK1 and LGR5 have been identified in patients with colon adenocarcinomas, indicating their role in initiating metastatic tumors (Kantara et al., 2014). Moreover, the detection of epithelial-to-mesenchymal transition (EMT) markers in CTCs has provided insights into their ability to evade immune surveillance and establish secondary tumors (Masuda et al., 2016). These molecular profiles not only enhance our understanding of CTC biology but also pave the way for personalized treatment strategies. 5.4 Case studies and clinical trials Several case studies and clinical trials have demonstrated the clinical utility of CTCs in the management of colon cancer. For instance, a meta-analysis involving 3,687 patients with non-metastatic colorectal cancer highlighted the prognostic value of CTC detection, showing a significant association with disease progression and survival outcomes (Lu et al., 2017). Another study involving 149 patients with colorectal cancer found that CTC counts
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