IMMUNOCYTOCHEMICAL DETECTION OF DISSEMINA TED EPITHELIAL TUMOR-CELLS IN BONE-MARROW OF PATIENTS WITH PANCREATIC-CARCINOMA

Introduction: Minimal residual disease in patients with operable pancr eas carcinoma is frequently missed by current non-invasive tumor stagi ng. Purpose: We applied an immunocytochemical cytokeratin assay that a llows the identification of individual pancreas carcinoma cells dissem inated to bone marrow. Methods: Prior to therapy bone marrow was aspir ated from the upper iliac crest of 42 patients with pancreas carcinoma and a control group of 30 non-carcinoma patients. Tumor cells in cyto logic bone marrow preparations mere detected with monoclonal antibodie s (mAbs) CK2, KL1 and A45-B/B3 to epithelial cytokeratins (CK), using the APAAP-method. Results: CK-positive cells were found in 14 (58.3 %) of 24 cancer patients treated in curative intent and 10 (55.6 %) of 1 8 patients with extended disease. After a mean follow up of 12.7 (3-32 ) months, 6 (42.8 %) out of 14 patients who underwent complete surgica l resection presented with tumor relapse and 5 (35.7 %) vvith distant metastases as compared to none of 10 corresponding patients without su ch cells (p < 0.04). Moreover, patients with epithelial tumor cells in bone marrow showed also a significantly shorter overall survival than those without tumor cells (p < 0.03). Conclusion: Immunocytochemical screening for epithelial tumor cells in bone marrow might contribute t o an improved staging and is of prognostic relevance for pancreas carc inoma patients.