S. Leinung et al., Cytokeratin-positive cells in bone marrow in comparison with other prognostic factors in colon carcinoma, LANG ARCH S, 385(5), 2000, pp. 337-343
Background and aims. Despite the use of radical locoregional therapeutic me
thods and although conventional methods of diagnosis give no indication of
metastases at the time of operation, distant metastases develop in approxim
ately 50% of carcinoma patients within 5 years. While local relapses after
the RO resection of solid tumors are mainly a matter of concern for the sur
geon, distant metastases can be traced back to the systemic dissemination o
f tumor cells at the time of operation, Patients/methods: A prospective stu
dy is presented in which 145 patients suffering from colon carcinoma were a
nalyzed for the prognostic relevance of isolated disseminated tumor cells d
etected in the bone marrow (IDT BM). The patients were operated on between
1993 and 1997 and subsequently observed until 1999. Results. The monoclonal
antibody A45-B/B3 was used with the immunocytochemical standard method for
detecting IDT BM. For the purpose of cell cultivation, the cells were mark
ed with the HEA-125 antibody and separated by means of magnetic cell sortin
g (MACS). Conclusion: In this investigation the presence of isolated dissem
inated tumor cells, as indicated by the A45-B/B3 antibody, proved to be an
independent prognostic factor for survival time. The risk of an earlier dea
th increased in node-negative and metastases-free patients with the detecti
on of IDT BM by a factor of 12.60. The detection of IDT BM also represented
an independent prognostic factor for the time until advancement of the tum
or. The risk of an earlier relapse increased with the detection of dissemin
ated tumor cells in the bone marrow containing the A45-B/B3 antibody by a f
actor of 18.02. A generally acknowledged standardization of the method is d
esirable. Due to the importance of the independent prognostic IDT BM factor
, this method of ascertaining the pathological stage should be established
at institutions of higher learning.