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10.1245/s10434-006-9039-3
Annals of Surgical Oncology 14:373-380 (2007)
© 2007 Society of Surgical Oncology
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Original Article

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

Stephan Gretschel, MD1, Christian Schick1, Ulrike Schneider, MD2, Lope Estevez-Schwarz, MD1, Andreas Bembenek, MD1 and Peter M. Schlag, MD, PhD1

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

Correspondence: Address correspondence and reprint requests to: Peter M. Schlag, MD, PhD; E-mail: pmschlag{at}charite.de

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 x 106 bone marrow cells (mean, 35 months) than in patients with ≤2 CK-positive cells per 2 x 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 x 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.

Key Words: Gastric cancer • Bone marrow • Epithelial cells




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X.-R. Yang, Y. Xu, G.-M. Shi, J. Fan, J. Zhou, Y. Ji, H.-C. Sun, S.-J. Qiu, B. Yu, Q. Gao, et al.
Cytokeratin 10 and Cytokeratin 19: Predictive Markers for Poor Prognosis in Hepatocellular Carcinoma Patients after Curative Resection
Clin. Cancer Res., June 15, 2008; 14(12): 3850 - 3859.
[Abstract] [Full Text] [PDF]


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