Hsu CP S L, Chen C Y, Kwang P C, Miao J, Hsia J Y, Shai S E
Division of Thoracic Surgery, Taichung Veterans Hospital, Taichung, Taiwan, R.O.C.
Eur J Surg Oncol. 2000 Nov;26(7):691-5. doi: 10.1053/ejso.2000.0982.
This study aimed to examine the incidence of bone-marrow microinvolvement in non-small cell lung cancer (NSCLC) patients and its correlation with tumour recurrence and prognosis.
Between March 1997 and August 1998, we analysed 96 bone-marrow specimens (from the posterior iliac crest) of NSCLC patients before surgery. Tumour differentiation showed well differentiated carcinoma in six, moderately differentiated carcinoma in 69, and poorly differentiated carcinoma in 21. p-TNM staging showed stage Ia in five, stage Ib in 33, stage IIb in 19, stage IIIa in 26, stage IIIb in eight, and stage IV in five. The specimens were examined by immunohistochemical staining with anti-human cytokeratin AE1/AE3 and clone MNF116 mixed solution (Ab1, n=96) and/or Ber-EP4 (Ab2, n=80) to detect the presence of malignant epithelial cells in the bone marrow.
Positive results were observed in 21 patients (21. 9%). The occurrence of bone-marrow microinvolvement was not related to patient age, sex, cell type, or TNM status. The 30-month disease-free survival rates were 50.2% and 53.9% in bone-marrow negative and bone-marrow positive patients, respectively (P=0.5670); the 30-month cumulative survival rates were 66.7% and 67.6% in bone-marrow negative and bone-marrow positive patients, respectively (P=0.9351). Multivariate analysis failed to demonstrate bone-marrow microinvolvement as an independent prognostic factor.
Our results show that bone-marrow microinvolvement is not unusual, and its occurrence cannot be translated into early tumour recurrence or poor outcome during an intermediate-term follow-up, which means bone-marrow microinvolvement may be an epiphenomenon rather than true metastasis in NSCLC.
本研究旨在检测非小细胞肺癌（NSCLC）患者骨髓微转移的发生率，并探讨其与肿瘤复发及预后的相关性。
1997年3月至1998年8月期间，我们分析了96例NSCLC患者术前（取自髂后嵴）的骨髓标本。肿瘤分化程度显示，高分化癌6例，中分化癌69例，低分化癌21例。p-TNM分期显示，Ia期5例，Ib期33例，IIb期19例，IIIa期26例，IIIb期8例，IV期5例。采用抗人细胞角蛋白AE1/AE3和克隆MNF116混合液（抗体1，n = 96）及/或Ber-EP4（抗体2，n = 80）进行免疫组化染色，检测骨髓中恶性上皮细胞的存在情况。
21例患者（21.9%）检测结果呈阳性。骨髓微转移的发生与患者年龄、性别、细胞类型或TNM分期无关。骨髓阴性和阳性患者的30个月无病生存率分别为50.2%和53.9%（P = 0.5670）；30个月累积生存率分别为66.7%和67.6%（P = 0.9351）。多因素分析未能证实骨髓微转移是独立的预后因素。
我们的结果表明，骨髓微转移并不罕见，在中期随访期间，其出现并不意味着肿瘤早期复发或预后不良，这意味着骨髓微转移在NSCLC中可能是一种附带现象而非真正的转移。
