IMMUNOCYTOLOGICAL DETECTION OF DISSEMINAT ED CANCER-CELLS IN THE PERITONEAL-CAVITY AND THE BONE-MARROW OF PANCREATIC-CANCER PATIENTS

Despite radical surgical treatment, the prognosis of patients with pan creatic cancer is poor. The success of surgical treatment is often lim ited due to local recurrence and especially the development of metasta ses and peritoneal carcinosis by cells which have been seeded already at the time of operation. Immunocytological methods enabled the detect ion of disseminated cancer cells before their clinical manifestation a s demonstrated by this study. Lavage samples from the peritoneal cavit y and bone marrow samples from 34 patients with an adenocarcinoma of t he pancreas were investigated with a panel of six different monoclonal antibodies against tumor-associated antigens (CEA, CA-19-9, 17-1A, C- 54-0, Ra96) and cytokeratin, respectively. Additionally, 43 patients w ith benign diseases were investigated as a control group. By this meth od, micrometastases were detected either in the bone marrow or the per itoneal cavity in 76% of pancreatic cancer patients. The occurrence of stained cells in the peritoneal cavity and bone marrow samples correl ated with the tumor stage and showed even in early stages (I and II) a detection rate of 43% (bone marrow) and 33% (peritoneal cavity), resp ectively. No unspecific reactions were found in the control group. The 1-year follow-up shows a significant correlation between tu mor cell detection and the survival (p = 0.03). Our study demonstrates that in most patients pancreatic cancer is a disseminated disease at time of d iagnosis. It underlines the need for adjuvant postoperative therapy co ncepts.