Occult tumor cells in bone marrow of patients with locoregionally restricted ovarian cancer predict early distant metastatic relapse
Occult tumor cells in bone marrow of patients with locoregionally restricted ovarian cancer predict early distant metastatic relapse
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DOI：
10.1200/jco.2001.19.2.368
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发表时间：
2001-01-15
影响因子：
45.3
通讯作者：
Pantel, K
中科院分区：
文献类型：
--
作者：
Braun, S;Schindlbeck, C;Pantel, K
目的：根据传统的肿瘤分期，原发性卵巢癌被认为是一种腹膜内疾病，很少扩散到腹膜外器官。然而，尸检研究显示隐匿转移率要高得多，表明腹膜外扩散发生的频率比以前认为的要高得多。因此，我们调查了早期血液传播的发生率及其与远处无病和总生存率的关系。患者和方法：采用新型抗细胞角蛋白（CK）抗体A45-B/B3对108例新诊断为国际妇产科联合会I至III期卵巢癌患者的骨髓抽吸液进行前瞻性分析。我们研究了骨髓中ck阳性肿瘤细胞的频率及其对预后的影响与肿瘤进展的既定危险因素有关。结果：108例患者中32例（30%）骨髓中检出肿瘤细胞。除了原发肿瘤的核分级差外，ck阳性发现与既定的风险参数无关。中位随访时间为45个月（12 ~ 77个月），骨髓中隐匿性转移细胞的存在与临床明显的腹膜外（主要是骨骼外）远处转移的发生相关(相对危险度[RR]， 16.5； 95%可信区间[CI]， 6.2 ~ 56.9
Purpose: Based on conventional tumor staging, primary ovarian cancer is viewed as an intraperitoneal disease that rarely spreads to extraperitoneal organs. However, autopsy studies reveal a much higher rate of occult metastasis, indicating that extraperitoneal spread occurs with much greater frequency than previously appreciated. Consequently, we investigated the incidence of early hematogenous dissemination and its association with distant disease-free and overall survival.Patients and Methods: Bone marrow aspirates from 108 patients newly diagnosed with International Federation of Gynecology and Obstetrics stage I to III ovarian cancer were prospectively analyzed with the novel anti-cytokeratin (CK) antibody A45-B/B3. We investigated the frequency of CK-positive tumor cells in bone marrow and their effect on prognosis in relation to established risk factors for tumor progression.Results: Tumor cells in bone marrow were detected in 32 (30%) of 108 patients. A CK-positive finding was unrelated to established risk parameters, except for poor nuclear grading of the primary tumor. At a median follow-up of 45 months (range, 12 to 77 months), the presence of occult metastatic cells in bone marrow was associated with the occurrence of clinically overt, extraperitoneal (predominantly extraskeletal) distant metastasis (relative risk [RR], 16.5; 95% confidence interval [CI], 6.2 to 56.9; P