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Masahiko TSURUMARU, Yoshiaki KAJIYAMAObjective: In recent years, circulating tumor cells (CTCs) have attracted attention for prediction of metastasis in breast, prostate, and colon cancers. This study aimed to investigate whether detection of CTCs could be prognostic factor in esophageal cancer.Methods: This study involved 38 patients treated at Juntendo University from May 2010 to April 2013 who provided consent. CTCs were measured using CellSearch® system in preoperative peripheral blood. Clinicopathological parameters and prognostic factors were retrieved from our medical records.Results: CTCs were detected in 6 of 38 patients (15.8%). Among patients’ characteristics and clinicopathological features, CTC-positive group had higher serum SCC levels and tended to have more advanced cStages than the CTC-negative group. The CTC-negative group showed better survival curves than CTCs positive-group in both overall survival (OS) and disease-free survival (DFS) although the differences were not statistically significant. CTCs positivity has a possibility to be prognostic marker according to multivariable analysis of OS and DFS.Conclusion: Although this study has some limitations, our results suggest that CTCs in preoperative peripheral blood has potential to be a prognostic marker for esophageal cancer.Key words: esophageal cancer, hematogenous metastasis, circulating tumor cells, cellsearch®Juntendo Medical Journal2022. 68(4), 369-374Original ArticlesClinical Significance of Circulating Tumor Cells in Patients with Esophageal CancerIntroductionAmong various cancers, approximately 25,920 new esophageal cancer cases are reported in Japa-nese national surveillance of 20181), and this number is steadily increasing2). Lymph node metastasis is the most common metastasis in resectable esopha-geal cancer; however, recurrence occurs in various sites. Of these, distant recurrences occur frequently and define prognosis after radical surgery with extensive lymph node dissection.We sometimes encounter patients whose tumor marker levels in peripheral blood had increased before recurrence, or metastasis was detected by diagnostic imaging such as computed tomography, ultrasonography, magnetic resonance imaging, and Department of Esophageal and Gastroenterological Surgery, Juntendo University Graduate School of Medicine, Tokyo, JapanCorresponding author: Motomi NasuDepartment of Esophageal and Gastroenterological Surgery, Juntendo University Graduate School of Medicine2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan 113-8421TEL: +81-3-3813-3111　FAX: +81-3-5802-1951　E-mail: mnasu@juntendo.ac.jp〔Received　Dec. 3, 2021〕〔Accepted　May. 23, 2022〕J-STAGE Advance published date: Aug. 1, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ21-0049-OApositron emission tomography. Thus, more sensi-tive modalities are expected in clinical practice to detect the so-called “micrometastasis.” One of these micrometastases are circulating tumor cells (CTCs). In this decade, immunohistochemical methods and polymerase chain reaction methods have been used to verify the presence of CTCs in peripheral blood in advanced cancers; however, there is no estab-lished detection method3).Recent studies have shown CTCs in peripheral blood of metastatic patients might be suggest poor prognosis4-6), and if CTC detection becomes possible in clinical practice, it will be useful for assessing a prognosticator and predicting early therapeutic effects. Although the clinical significance of CTC detection technology had not been established, 369Hiromi KITANO, Motomi NASU, Takashi HASHIMOTO,