Study of hematogenous micrometastases by RT-nested PCR of CEA mRNA in patients with esophageal cancer receiving chemoradiotherapy

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Introduction : Esophageal cancer is a highly virulent disease. Recent reported results of chemoradiotherapy (CRT) have indicated various advantages of this treatment against advanced esophageal cancer. In early stages, definitive CRT as well as surgical resection provide good results. In advanced stages of the disease, neo-adjuvant CRT followed by surgery improve primary tumor resectability and overall survival. However, some patients die due to distant spread shortly after surgery. Those patients may already have had micrometastases before surgical resection. Thus, early detection of micrometastasis is an issue of utmost importance. In this study, we attempted to detect hematogenous micrometastasis by RT-PCR of CEA mRNA in patients with esophageal cancer receiving CRT and evaluated the clinical significance.Methods : A total of 55 esophageal cancer patients who underwent CRT in our university hospital between 2001 and 2004 were studied. Thirty-three of 55 patients received surgery aft … More er CRT. Blood samples were aspirated from peripheral vein at pre- and post-CRT, and post-surgery. After total RNA was extracted from each blood sample, CEA-specific RT-nested PCR was performed. All patients were followed-up for one year.Results : The positive expression of CEA mRNA before CRT was 52.7% (29/55). CEA mRNA before CRT correlated with lymph node metastasis and clinical stage. The number of cases with positive expression of CEA mRNA decreased after CRT (41.8%, 23/55). The expression of CEA mRNA also changed after surgery in 6 patients ; 5 patients became negative and one patient became positive. Expression of CEA mRNA after final treatments correlated recurrence and a poor prognosis.Conclusion : CEA mRNA is a sensitive and specific molecular marker for detection of micrometastasis in peripheral blood of patient with esophageal cancer. It can help to predict the prognosis of esophageal cancer after final treatment, and to determine which patient will benefit from aggressive adjuvant therapies. Less