Steinert Ralf, Hantschick Marco, Vieth Michael, Gastinger Ingo, Kühnel Frank, Lippert Hans, Reymond Marc A
Department of Surgery, Evangelic Hospital Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
Arch Surg. 2008 Feb;143(2):122-8. doi: 10.1001/archsurg.2007.49.
To determine epithelial cell dissemination in patients with localized colorectal cancer.
Prospective observational study.
Academic hospital.
Two hundred twenty-two patients operated on for colorectal cancer.
Epithelial cell dissemination was determined using immunohistochemistry or cytology in histologically negative lymph nodes, the peritoneal cavity, and bone marrow. Prognostic significance was determined in relation to 140 clinicopathological variables. Median follow-up was 61 months.
Of 140 patients who underwent curative surgery; 25 (17.9%) died of cancer-related causes; 10 (7.1%), of other causes; and 11 (7.8%) developed local recurrence. Tumor cells were present in the peritoneal cavity of 22% of patients, but this finding had only borderline influence on disease-free survival (P = .07). Lymph node micrometastases correlated with T category but not with survival. The presence of epithelial cells in the bone marrow was detected in 64% of patients but was not associated with tumor stage or survival. Multivariate analysis failed to identify occult tumor cell dissemination into any body compartment as an independent prognostic factor of disease-free survival.
Tumor cells disseminate into various body compartments in early stages of disease. In about two-thirds of patients, tumor cells are left in the body after so-called curative surgery. However, the presence of minimal residual disease has no independent prognostic significance in relation to established risk factors for tumor progression. Thus, other factors, such as the presence of a cellular metastatic phenotype and/or ineffective immunological response, must play an important role.
确定局限性结直肠癌患者的上皮细胞播散情况。
前瞻性观察研究。
学术医院。
222例接受结直肠癌手术的患者。
采用免疫组织化学或细胞学方法，在组织学检查阴性的淋巴结、腹腔和骨髓中确定上皮细胞播散情况。根据140个临床病理变量确定其预后意义。中位随访时间为61个月。
140例行根治性手术的患者中，25例（17.9%）死于癌症相关原因；10例（7.1%）死于其他原因；11例（7.8%）出现局部复发。22%的患者腹腔内存在肿瘤细胞，但这一发现对无病生存期仅有临界影响（P = 0.07）。淋巴结微转移与T分期相关，但与生存率无关。64%的患者骨髓中检测到上皮细胞，但与肿瘤分期或生存率无关。多变量分析未能将隐匿性肿瘤细胞播散至任何身体腔隙确定为无病生存期的独立预后因素。
肿瘤细胞在疾病早期播散至身体的各个腔隙。在约三分之二的患者中，所谓的根治性手术后体内仍残留肿瘤细胞。然而，微小残留病灶的存在与已确定的肿瘤进展风险因素无关，不具有独立的预后意义。因此，其他因素，如细胞转移表型的存在和/或无效的免疫反应，必定起着重要作用。
