Prognostic impact of hematogenous tumor cell dissemination in patients with stage II colorectal cancer
Prognostic impact of hematogenous tumor cell dissemination in patients with stage II colorectal cancer
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DOI：
10.1002/ijc.21784
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发表时间：
2006-06-15
影响因子：
6.4
通讯作者：
Weitz, Jurgen
中科院分区：
文献类型：
--
作者：
Koch, Moritz;Kienle, Peter;Weitz, Jurgen
对于UICC II期结直肠癌患者，常规不推荐辅助化疗。然而，其中一些患者会出现复发性疾病。因此，需要有效的预后标准来识别可能受益于辅助治疗的高危患者。弥散性肿瘤细胞，在血液和骨髓中检测到，可能被证明是一个有效的标志物，然而，这些细胞的预后相关性仍然存在争议。在我们的研究中，我们研究了II期结直肠癌患者血液和骨髓中弥散性肿瘤细胞的预后意义。90例潜在治愈（R0）切除的结直肠癌II期患者被前瞻性纳入研究。采用ck20 RT-PCR检测骨髓和血液中是否有弥散性肿瘤细胞。分析患者、肿瘤及治疗因素作为预后因素。多因素分析证实血液中肿瘤细胞检测（风险比2.1,p = 0.03）和t型（风险比2.2,p = 0.02）是影响无复发生存的独立预后因素。术后血液样本肿瘤细胞检测（风险比7.7,p < 0.001）和淋巴结切除数（风险比6.4,p < 0.001）是疾病特异性生存的独立预后因素。H期结直肠癌患者血液样本中循环肿瘤细胞的检测可识别预后不良的患者。这一发现有待进一步的研究证实，并可作为评估II期患者辅助化疗效果的随机试验的基础。(c) 2006 Wiley-Liss。
Adjuvant chemotherapy is not routinely recommended in patients with colorectal cancer stage UICC II. Some of these patients, however, develop recurrent disease. Therefore, valid prognostic criteria are needed to identify high-risk patients who might benefit from adjuvant therapy. Disseminated tumor cells, detected in blood and bone marrow, may prove to be a valid marker, however, the prognostic relevance of these cells remains debated. In our study, we examined the prognostic significance of disseminated tumor cells in blood and bone marrow of patients with stage II colorectal cancer. Ninety patients with potentially curative (R0) resection of colorectal cancer stage II were prospectively enrolled into the study. Bone marrow and blood samples were examined for disseminated tumor cells by CK 20 RT-PCR. Patient, tumor and treatment factors were analyzed as prognostic factors. Multivariate analysis confirmed tumor cell detection in blood (hazard ratio 2.1, p = 0.03) and T-category (hazard ratio 2.2, p = 0.02) to be independent prognostic factors for relapse-free survival. Tumor cell detection in postoperative blood samples (hazard ratio 7.7, p < 0.001) and number of removed lymph nodes (hazard ratio 6.4, p < 0.001) were independent prognostic factors for disease-specific survival. Detection of circulating tumor cells in blood samples of patients with stage H colorectal cancer identifies patients with poor outcome. This finding should be confirmed by further studies and could then be used as a basis for conducting a randomized trial evaluating the effect of adjuvant chemotherapy in stage II patients. (c) 2006 Wiley-Liss, hic.