Objective To analyze the relationship between circulating tumor cells (CTCs) in peripheral blood and chemotherapy response, tumor recurrence and metastasis of pancreatic cancer. Methods 100 patients with pancreatic cancer, 30 healthy individuals and 30 patients with benign pancreatic diseases were enrolled. The expression of CTCs in peripheral blood was detected. Tumor recurrence and metastasis, and survival of patients with pancreatic cancer during postoperative followup were recorded. The relationship between CTCs expression and clinical characteristics of pancreatic cancer patients, chemotherapy efficacy, tumor recurrence, metastasis were analyzed. Results The positive rate of CTCs in pancreatic cancer group was significantly higher than that in benign disease group and that in control group (P＜005). The positive rates of CTCs in patients in tumor stage ⅢⅣ and with poor differentiated tumors were significantly higher than those in patients in tumor stage ⅠⅡ and with highly/moderately differentiated tumors (P＜005). Logistic regression analysis showed that tumor staging and differentiation degree were related to CTCs positive in patients with pancreatic cancer (P＜005). There were 42 cases (4200%) with objective remission and 71 cases (7100%) with disease under control by chemotherapy. The positive rate of CTCs in patients with disease control was significantly lower than that with disease progression (P＜005). It was found by KaplanMeier survival analysis that the 1year survival rate in CTCs positive patients was significantly lower than that in CTCs negative patients (x2=5114, P=0024), and recurrence metastasis rate within 1 year was significantly higher than that in CTCs negative patients (x2=4479, P=0034). Conclusion The expression of CTCs in peripheral blood is closely related to tumor staging and differentiation degree of pancreatic cancer. The chemotherapy effect is relatively worse in CTCs positive patients after surgery, and there are higher risks of tumor recurrence, metastasis and death.