title: Detection of circulating tumor cells in colorectal cancer by immunobead-PCR is a sensitive prognostic marker for relapse of disease.
abstract: BACKGROUND
  Recurrent and metastatic carcinoma of the colorectum remains a major problem, with survival at 5 years post curative resection still only about 50%. Moreover, up to 30% of patients who present with early stage disease also relapse and die within 5 years, suggesting the presence of micrometastatic disease at diagnosis. One route of metastatic spread is via the blood stream, hence the detection of tumor cells in blood is likely to provide an important predictive tool with respect to relapse of disease. We have developed a sensitive molecular technique to identify tumor cells in blood using mutations in codon 12 of the K-ras gene as a marker.
  
  
  METHODS
  Twenty-seven patients whose tumor carried a mutation in codon 12 of K-ras were studied for the presence of tumor cells in perioperative peripheral blood samples. Immunomagnetic beads, labeled with an epithelial-specific antibody, were used to harvest epithelial cells from blood. K-ras mutations were identified in this selected population using a polymerase chain reaction (PCR)-based analysis (immunobead-PCR).
  
  
  RESULTS
  Circulating K-ras mutant cells were detected in 9 or 27 patients; seven of these nine patients have since died due to recurrent or metastatic disease. Mutant cells were not detected in 18 patients, and 16 or 18 have remained disease free (median follow-up: 16 months; range: 7-42 months). Kaplan-Meier analysis showed that detection of K-ras mutant cells in bloods was associated with significantly reduced disease-free survival (p = 0.0001).
  
  
  CONCLUSIONS
  This study indicates that detection of circulating tumor cells perioperatively by immunobead-PCR provides a sensitive prognostic marker for recurrent and metastatic colorectal cancer.
authors.affiliation: Department of Hematology-Oncology, Queen Elizabeth Hospital, Woodville, South Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Hardingham
authors.forename: D
authors.initials: D
authors.lastname: Kotasek
authors.forename: R E
authors.initials: RE
authors.lastname: Sage
authors.forename: M C
authors.initials: MC
authors.lastname: Eaton
authors.forename: V H
authors.initials: VH
authors.lastname: Pascoe
authors.forename: A
authors.initials: A
authors.lastname: Dobrovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000556:secondary; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D011905:Genes, ras; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009360:Neoplastic Cells, Circulating; D016133:Polymerase Chain Reaction / Q000379:methods*; D012008:Recurrence