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Prognostic Value of Cytokeratin-Positive Bone Marrow Cells of Gastric Cancer Patients

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Abstract

Background

Epithelial cells in the bone marrow of patients with gastric cancer suggest tumor dissemination; however, their prognostic implications are controversial. We prospectively evaluated the correlation of bone marrow findings, recurrence rate, and disease-free survival after long-term follow-up.

Methods

Bone marrow were aspirated from both iliac crests and stained with monoclonal cytokeratin (CK)-18 antibody in 209 patients before their initial operation. Patients were followed up for a median of 56 months.

Results

Overall, 39 (19%) of 209 patients and 15 (14%) of 109 R0-resected patients had CK-positive cells. CK-positive patients had more local, regional, and distant recurrence than CK-negative patients (P < .05). We found a significantly shorter disease-free survival (P < .05) in the patients with >2 CK-positive cells per 2 × 106 bone marrow cells (mean, 35 months) than in patients with ≤2 CK-positive cells per 2 × 106 bone marrow cells (mean, 70 months) or in patients with no CK-positive cells (mean, 86 months). Multivariate analysis confirmed that >2 CK-positive cells per 2 × 106 bone marrow cells was an independent prognostic factor for tumor-related death (P < .05).

Conclusions

Not only the mere presence of CK-positive epithelial cells in bone marrow, but also the cell number, correlates with prognosis. Our findings suggest that classifying CK-positive bone marrow cells in these patients will facilitate future studies.

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Acknowledgment

The authors thank Markus Niederstrasser for his assistance in statistical analysis.

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Authors and Affiliations

  1. Department of Surgery and Surgical Oncology, Charité-Universitätsmedizin Berlin, Campus Buch, Robert-Rössle-Klinik at the Helios Klinikum Berlin, Lindenberger Weg 80, 13125, Berlin, Germany

    Stephan Gretschel MD, Christian Schick, Lope Estevez-Schwarz MD, Andreas Bembenek MD & Peter M. Schlag MD, PhD

  2. Institute of Pathology, Charité-Universitätsmedizin Berlin, Campus Buch, Robert-Rössle-Klinik at the Helios Klinikum Berlin, Lindenberger Weg 80, 13125, Berlin, Germany

    Ulrike Schneider MD

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  1. Stephan Gretschel MD
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  2. Christian Schick
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Correspondence to Peter M. Schlag MD, PhD.

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Gretschel, S., Schick, C., Schneider, U. et al. Prognostic Value of Cytokeratin-Positive Bone Marrow Cells of Gastric Cancer Patients. Ann Surg Oncol 14, 373–380 (2007). https://doi.org/10.1245/s10434-006-9039-3

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