Clinical significance of molecular detection of carcinoma cells

目的：本研究探讨胃肠道或乳腺癌患者淋巴结及标本微转移的临床意义及预后预测价值。结果：(a)血液；1)预测值：MACS（磁性细胞分选系统）可提高结肠癌患者瘤周引流静脉癌细胞的检出率和敏感性。引流静脉K-ras突变7例，术后8月和15月复发2例（29%）。另一方面，没有K-ras突变的17例患者中，只有1例（6%）复发。2)临床应用：10例复发或晚期患者化疗前外周血检测CEAmRNA，治疗过程中3例（30%）CEAmRNA消失，有助于监测化疗情况。接受手术的患者可以储存他们的CEAmRNA阴性的血液，以备更多的输血，确保癌细胞不受污染。(B)淋巴结：1)预测价值：28例组织学阴性但CEAmRNA阳性的淋巴结（28/64=44%）中，3例（1例胃癌、1例结肠癌、1例食管癌）复发。2)临床应用：RT-PCR提高了淋巴结癌细胞的检出率和敏感性。前哨淋巴结无微转移者可省去早期乳腺癌腋窝淋巴结清扫。我们建立了快速RT-PCR技术，可在60分钟内完成手术过程中的实际分子诊断。结论：研究表明，RT-PCR是检测血液或淋巴结中极少数癌细胞的有力工具。缩短时间的RT-PCR技术对于确定转移高危患者或需要进行微创手术的患者具有潜在的非常有用的价值。有可能根据微转移的存在为每个病例选择不同的策略。少

PURPOSE : This study evaluated the clinical significance and predictive values for patients' prognosis of micrometastasis in the lymph nodes and samples of patients' with gastrointestinal or breast carcinomas.RESULTS : (A) BLOOD ; 1) Predictive values : Detection rate and sensitivity of cancer cells in peritumoral draining vein were increased using MACS(magnetic cell sorting system) for colon cancer patients. Of 7 cases with K-ras mutation in the draining vein, 2 cases (29%) developed recurrent disease after curative operation at 8 or 15 months, respectively. On the other hands, of 17 cases without K-ras mutation, only one case (6%) developed recurrence. 2) Application for clinical use : CEAmRNA was detected in peripheral bloods of 10 cases with recurrent or advanced disease before chemotherapy, CEAmRNA was disappeared in 3 cases (30%) during the therapy, this was useful for monitoring the chemotherapy. The patients who underwent operation could store their CEAmRNA negative blood for a … More transfusion, ensuring no contamination of cancer cells.(B) LYMPH NODES : 1) Predictive value : Of twenty-eight patients with histologically negative but CEAmRNA positive lymph nodes (28/64=44%), 3 cases (1 gastric, 1 colon, 1 esophageal cancer) developed recurrent disease. 2) Application for clinical use : Detection rate and sensitivity of cancer cells in lymph nodes were increased by RT-PCR. The patients without micrometastasis in the sentinel lymph node might save axillary nodes dissection of early breast cancer patients. We have established prompt RT-PCR technique which can be preformed within 60 minutes for practical molecular diagnosis during operation.CONCLUSION : It has been shown that RT-PCR is a powerful tool to detect very small number of cancer cells in the blood or the lymph nodes. The time-shortened RT-PCR technique is potentially very useful to determine the patients at high-risk for metastasis or patients indicative for less invasive surgery. It would be possible to choose various strategies for each case based on presence of mirometastasis. Less