Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
BMC Cancer. 2010 Apr 20;10:153. doi: 10.1186/1471-2407-10-153.
Large number of patients with colorectal liver metastasis show recurrent disease after curative surgical resection. Identification of these high-risk patients may guide therapeutic strategies. The aim of this study was to evaluate whether the presence of disseminated tumor cells in bone marrow from patients undergoing surgical resection of colorectal liver metastases can predict clinical outcome.
Sixty patients with colorectal liver metastases were planned for a curative resection between 2001 and 2007. All patients underwent bone marrow aspiration before surgery. Detection of tumor cells was performed using immunocytochemical staining for cytokeratin (CK-ICC) combined with automated microscopy or indirectly using reverse transcription-polymerase chain reaction (RT-PCR).
Disseminated tumor cells were found in 15 of the 46 patients (33%) using CK-ICC and in 9 of 44 of the patients (20%) using RT-PCR. Patients with negative results for RT-PCR had a significant better disease-free survival after resection of their liver metastases (p = 0.02). This group also showed significant better overall survival (p = 0.002). CK-ICC did not predict a worse clinical outcome.
The presence of disseminated tumor cells in bone marrow detected using RT-PCR did predict a worse clinical outcome. The presence of cells detected with CK-ICC did not correlate with poor prognosis.
大量结直肠癌肝转移患者在根治性手术后出现复发。识别这些高危患者可能有助于指导治疗策略。本研究旨在评估结直肠癌肝转移患者骨髓中是否存在播散性肿瘤细胞是否可以预测临床结局。
2001 年至 2007 年间，计划对 60 例结直肠癌肝转移患者进行根治性切除术。所有患者均在手术前行骨髓穿刺。采用细胞角蛋白（CK-ICC）免疫细胞化学染色联合自动显微镜或间接采用逆转录-聚合酶链反应（RT-PCR）检测肿瘤细胞。
46 例患者中有 15 例（33%）采用 CK-ICC 检测到播散性肿瘤细胞，44 例患者中有 9 例（20%）采用 RT-PCR 检测到播散性肿瘤细胞。RT-PCR 结果为阴性的患者在切除肝转移灶后无疾病生存率显著提高（p=0.02）。该组的总生存率也显著提高（p=0.002）。CK-ICC 未预测出较差的临床结局。
采用 RT-PCR 检测到骨髓中播散性肿瘤细胞可预测较差的临床结局。用 CK-ICC 检测到的细胞存在与否与预后不良无关。
