Detection of bone marrow micrometastasis in gastrointestinal cancer patients by immunomagnetic separation

检测到骨髓微转移可以预测癌症患者的广泛疾病和不良预后。本研究旨在探讨检测胃肠道肿瘤患者骨髓微转移的临床意义。采集53例胃癌和52例食道癌患者手术时的骨髓和外周血标本。这些样品经免疫磁性分离后，用抗细胞角蛋白抗体进行免疫染色。检测血管内皮生长因子(VEGF)、人表皮生长因子2(HER2)和细胞周期蛋白D1在原发肿瘤中的表达。胃癌组16例(30%)、食道癌组13例(25%)骨髓细胞角蛋白阳性。骨髓微转移与淋巴结转移(PN)相关，与肿瘤深度(PT)无关。检测到骨髓微转移与胃癌腹膜转移无关。食道癌骨髓微转移患者的累积生存期明显低于无骨髓微转移患者。有骨髓微转移的患者血源性复发比无微转移的患者更常见。局部或播散性复发的患者无骨髓微转移。骨髓癌细胞的检测可能是胃肠道肿瘤患者早期血行转移的一个指标。对于这些患者，似乎需要进行术后强化化疗。

Detection of micrometastasis to the bone marrow can predict widespread disease and a poor prognosis of cancer patients. The purpose of this study was to evaluate the clinical significance of detecting micrometastasis in the bone marrow of gastrointestinal cancer patients. Bone marrow and peripheral blood samples were obtained from 53 gastric and 52 esophageal cancer patients at the time of surgery. These samples were enriched by immunomagnetic separation and immunostained with an anti-cytokeratin antibody. Expression of vascular endothelial growth factor (VEGF) human epidermal growth factor 2 (HER2), and cyclin D1 was examined in the primary tumors. Cytokeratin-positive cancer cells were observed in the bone marrow of 16 (30%) in gastric cancer patients and 13 (25%) in esophageal cancer patients. The presence of bone marrow micrometastasis was correlated with lymph node metastasis (pN) but not associated with depth of tumors (pT). Detection of bone marrow micrometastasis was not associated with peritoneal dissemination in gastric cancer. Cumulative survival of patients with bone marrow micrometastasis was significantly lower than that of patients without it in esophageal cancer. Hematogenous recurrence was more frequent in patients with bone marrow micrometastasis than in those without it. The patients who had local or dissemination recurrence did not have bone marrow micrometastasis. Detection of cancer cells in the bone marrow might be an indicator of early hematogenous metastasis in gastrointestinal cancer patients. Intensive postoperative chemotherapy seems to be indicated for these patients.