L1CAM and metastatic malignant neoplasm in the lymph nodes: While earlier work indicated that ≥ 6 CTCs/5 mL and hybrid/mesenchymal phenotypes correlate with unfavorable progression-free survival (30), our study highlights the dominance of H-CTCs and the prognostic significance of L1CAM positivity, particularly in relation to lymph node metastasis and proliferative index (Ki-67).