Genetic Detection of Lymph Node Micrometastases: A Selection Criterion for Liver Transplantation in Patients with Liver Metastases after Colorectal Cancer
Genetic Detection of Lymph Node Micrometastases: A Selection Criterion for Liver Transplantation in Patients with Liver Metastases after Colorectal Cancer
复制标题
淋巴结微转移的基因检测：结直肠癌术后肝转移患者肝移植的选择标准
作者：
S. Kappel;D. Kandioler;R. Steininger;F. Längle;F. Wrba;M. Ploder;G. Berlakovich;T. Soliman;H. Hetz;S. Rockenschaub;E. Roth;F. Mühlbacher
背景由于结直肠癌肝转移的高复发率，1994年肝移植被放弃。本研究的目的是探讨原发性结肠癌组织学阴性淋巴结微转移的基因检测是否可以应用于选择肝移植患者。方法.我们分析了1983年至1994年间因肝转移而接受肝移植的21例结直肠癌患者。11例患者在手术时组织学淋巴结阴性; 10例淋巴结转移患者作为对照组。DNA测序用于筛选肿瘤材料的p53和K-ras突变。然后使用突变等位基因特异性扩增（MASA）从原发性结直肠癌的区域淋巴结中寻找DNA中的微转移。结果21例大肠癌中p53和K-ras基因突变分别为12例（57%）和3例（14%）。在相应的肝转移瘤中证实了突变。在11例组织学阴性的淋巴结患者中，9例由于存在p53或K-ras突变而符合MASA的条件。MASA显示9例患者中有6例为微转移基因阳性。3例患者在遗传学和组织学上均为阴性。这3例患者的总生存期显著延长（P=0.011），分别为4年、5年和20年。结论.我们的结论是，微转移基因检测MASA可能是一个强大的预后指标，选择结直肠癌肝转移患者谁可以受益于肝移植。
Background. Liver transplantation for nonresectable liver metastases from colorectal cancer was abandoned in 1994 on account of high recurrence rates. The aim of this study was to investigate whether the genetic detection of micrometastases in histologically negative lymph nodes of the primary colon cancer could be applied to select patients for liver transplantation. Methods. We analyzed 21 patients with colorectal cancer who had undergone liver transplantation between 1983 and 1994 for liver metastases. Eleven patients were histologically lymph node negative at the time of surgery; ten patients with lymph node metastases served as control group. DNA sequencing was used to screen tumor material for p53 and K-ras mutations. Mutant allele-specific amplification (MASA) was then used to search for micrometastases in DNA from regional lymph nodes of the primary colorectal cancer. Results. p53 and K-ras mutations were detected in 12 (57%) and 3 (14%) of 21 patients in the colorectal cancer, respectively. The mutations were confirmed in the corresponding liver metastases. Of 11 patients with histologically negative lymph nodes, nine were eligible for MASA due to presence of p53 or K-ras mutation. MASA revealed six of nine patients to be genetically positive for micrometastases. Three patients were both genetically and histologically negative. These three patients showed a significantly longer overall survival (P=0.011) of 4, 5, and 20 years, respectively. Conclusions. We conclude that the genetic detection of micrometastases by MASA could be a powerful prognostic indicator for selecting patients with colorectal liver metastases who could benefit from liver transplantation.
影响因子：
11.2
作者：
Joyce Bos
通讯作者：
Joyce Bos
DOI：
10.1634/theoncologist.4-3-197
发表时间：
1999-06
期刊：
The oncologist
影响因子：
--
作者：
Sam S. Yoon;Kenneth K. Tanabe
通讯作者：
Sam S. Yoon;Kenneth K. Tanabe