Molecular detection of circulating tumor cells by reverse transcriptase-polymerase chain reaction in patients with non-small cell lung cancer: A prospective study for clinical significance of micrometastasis

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We tested whether circulating tumor cells can be detected in the peripheral blood of patients with resectable non-small cell lung cancer (NSCLC) by reverse transcriptase-polymerase chain reaction (RT-PCR) of carcinoembryonic antigen (CEA) mRNA. We assayed for CEA mRNA by RT-PCR in the peripheral blood taken at the time of diagnosis before surgery and again 2 to 3 weeks after surgery from 103 patients with NSCLC who underwent a curative lobectomy. Blood taken from 15 patients with interstitial pulmonary fibrosis who underwent an open-lung biopsy and 32 healthy subjects served as controls. No control samples were positive for CEA by RT-PCR. Sixty-two (60.2%) of the preoperative blood samples from the 103 patients with NSCLC were positive. Of these 62, 27 (43.5%) remained positive even after surgery, while the remaining 35 (56.5%) became negative. The incidence of positive CEA mRNA correlated highly with pathologic TNM stage of disease both in the preoperative and postoperative blood samp … More les. Many patients with resectable NSCLC have detectable levels of circulating cells expressing carcinoembryonic antigen even after surgery. Next, we conducted a prospective study of 103 consecutive patients with NSCLC who underwent a curative lobectomy to test whether circulating tumor cells detected in the peripheral blood by RT-PCR of CEA mRNA is a prognostic indicator independent of tumor stage in patients with NSCLC. Patients with positive CEA mRNA in the preoperative blood samples had a poor survival when compared to those with negative CEA mRNA; of these patients, the worst survival rate was seen in those with positive CEA mRNA in the postoperative blood samples. The multivariate stepwise analysis selected the preoperative CEA mRNA expression and the pathologic stage of disease as the independent prognostic factors for survival. The molecular detection of CEA mRNA in the preoperative peripheral blood is an independent prognostic factor in patients with NSCLC who undergo a curative surgery. Less