Biological implications of tumor cells in blood and bone marrow of pancreatic cancer patients

K. Z'Graggen et al., Biological implications of tumor cells in blood and bone marrow of pancreatic cancer patients, SURGERY, 129(5), 2001, pp. 537-546
Citations number
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ISSN journal
0039-6060 → ACNP
Year of publication
537 - 546
SICI code
Background. Patients with pancreatic cancer often have tumor recurrence des pite curative resection. Cancer cells detected in blood or bone marrow at t he time of diagnosis may relate to tumor stage and to prognosis. Recent res earch emphasis has centered on tumor cells in bone marrow aspirates, but wh ether these represent early micrometastases or blood-borne cells in transit is unknown. Patients and Methods. We developed a specific immunocytochemical assay that evaluated more than 5.3 x 10(6) extracted mononuclear cells pm sample of b lood and bone marrow and that could identify a single tumor cell in that po pulation. The assay was applied to samples of blood and bone marrow from 10 5 patients with pancreatic cancer and 66 controls. The prevalence of isolat ed tumor cells was compared with Union Internationale Contre Ie Cancer (UIC C) stage. ii multivariate Cox regression analysis for survival was performe d. Results. Pancreatic cancer cells were detected in 26% of blood samples and in 24% of bone marrow specimens. Specificity for cancer was 96%. The preval ence of isolated tumor cells in patients with proven resectable cancer was 9% in blood and 13% in bone marrow. The prevalence increased with UICC tumo r stage in blood ( P =.04) but not In bone marrow (P =.52) and correlated i n blood with resectability (P =.02), progression of disease (P=.08), and pe ritoneal dissemination (P=.003). While survival correlated significantly wi th tumor stage (P <.001) and isolated tumor cells in blood correlated with tumor stage, the finding of cancer cells in blood or bone marrow, or both, was not independently associated with survival in patients with pancreatic cancer. Conclusions, Isolated tumor cells in blood but not bone marrow reflect the stage of growth and spread of pancreatic cancer, particularly in the perito neal cavity. The findings are consistent with cells in bone marrow aspirate s being in transit, not implanted. These disseminated cancer cells may be t he consequence, rather than the cause, of progression.