Micrometastases in esophagogastric cancer: high detection rate in resected rib segments.
OBJECTIVE
Micrometastases within bone marrow indicate a poor prognosis. We prospectively examined micrometastases in patients undergoing resection of esophagogastric cancers for (1) prevalence in rib marrow; (2) comparative detection rates in rib and iliac crest marrow; (3) responsiveness to neoadjuvant therapy; and (4) viability and tumorigenicity.


METHODS
In 50 consecutive patients, marrow was obtained before manipulation of the primary tumor. Micrometastatic cells were detected by staining contaminant cytokeratin-18-positive cells. Viability and tumorigenicity were determined by culture and xenograft.


RESULTS
Micrometastases were detected in rib marrow from 88% of patients (44 of 50). When bilateral iliac crest marrow was also obtained, micrometastases were found in 15% (4 of 27) compared with 89% (24 of 27) for ribs (P < 0.001). Detection rates were independent of histological type or nodal status and were similar in patients with and without neoadjuvant therapy. Metastatic cells were cultured from rib marrow of 5 of 7 patients and were tumorigenic in nude mice.


CONCLUSIONS
Most patients undergoing resection of esophagogastric malignancies have micrometastases in rib marrow. Detection rates based on iliac crest marrow are underestimates. Hematogenous spread of metastatic cells is independent of histological type or nodal status. The metastatic cells are viable, tumorigenic, and resistant to neoadjuvant therapy.
Department of Surgery, Mercy and Cork University Hospitals and National University of Ireland, University College Cork, Cork, Ireland.
G C
GC
O'sullivan
D
D
Sheehan
A
A
Clarke
R
R
Stuart
J
J
Kelly
M D
MD
Kiely
T
T
Walsh
J K
JK
Collins
F
F
Shanahan
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000818:Animals; D001853:Bone Marrow / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology; D005434:Flow Cytometry; D006801:Humans; D007085:Ilium; D007633:Keratins / Q000032:analysis; D051379:Mice; D008819:Mice, Nude; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011446:Prospective Studies; D012272:Ribs; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D014183:Transplantation, Heterologous
D007633:Keratins