Prognostische Bedeutung der Detektion disseminierter Tumorzellen bei Patienten mit Kolonkarzinom

Abstract

Aim: The prognostic impact of disseminated tumour cells is controversially discussed. In our prospective analysis preoperatively taken blood and bone marrow samples of patients with carcinoma of the colon were evaluated for disseminated tumour cells by cytokeratin 20 (CK 20) RT-PCR. Material and methods: 178 bone marrow and 226 blood samples were taken from 236 patients (1992–2002). According to the UICC-stages (1997) the distribution was: UICC stage I: 52 pat. (22%); II: 63 pat. (26.7%); III: 59 pat. (25%); IV a + b: 62 pat. (26.3%). 185 (78.3%) of the 236 patients were curatively (R0) resected. Patients follow up was between 3 and 103 months (mean: 27 months). Results: In both compartments detection of disseminated tumour cells increased with the UICC-stage (bone marrow: stage I: 32.4%, stage II: 34%, stage III: 34.9%, stage IV: 49%, overall 38.2%; blood: stage I: 33.3%, stage II: 35.5%, stage III: 38.2%, stage IV: 50%, overall: 39.4%).

Univariate survival analysis according to Kaplan-Meier revealed statistically significant differences between patients regarding the UICC-Stage (p = 0.0), lymph node status (p = 0.0), and with or without detection of CK 20 in the bone marrow (p = 0.0093), blood (p = 0.0003), and bone marrow and/or blood (p = 0.0014).

In the multivariate analysis the detection in blood (p = 0.0001) and in bone marrow and/or blood (p = 0.003) were demonstrated to be independent prognostic factors, whereas detection of disseminated tumour cells in bone marrow alone did not reach statistical significance (p = 0.116). Summary: Multivariate statistical analyses revealed an independent prognostic impact of the CK 20-specific RT-PCR test, when applied in blood as well as in blood and/or bone marrow samples of colon carcinoma patients.