Comparative analysis of tumor cell dissemination in mesenteric, central, and peripheral venous blood in patients with colorectal cancer.
BACKGROUND
Metastatic disease in colorectal cancer results from hematogenic dissemination of tumor cells. This dissemination can be explained by 2 concepts: (1) regional spread of tumor cells via portal venous drainage into the liver as the first site of metastasis and (2) early spread of tumor cells into central and peripheral venous blood as evidence of systemic hematogenic tumor cell dissemination.


OBJECTIVE
Tumor cell detection in different blood compartments could help to understand the predominant pattern of hematogenic tumor cell dissemination in colorectal cancer.


METHODS
Prospective consecutive series.


METHODS
University hospital.


METHODS
Mesenteric, central, and peripheral venous blood samples from 40 patients with colorectal cancer were examined by cytokeratin 20 reverse transcriptase polymerase chain reaction.


METHODS
Sensitivity and specificity of cytokeratin 20 reverse transcriptase polymerase chain reaction, and frequency of tumor cell detection in different blood compartments.


RESULTS
Tumor cells were found in mesenteric venous blood of 20 of 40 patients, central venous blood of 6 of 40 patients, and peripheral venous blood of 2 of 19 patients. The detection rate in mesenteric venous blood was significantly higher than that in central and peripheral venous blood (P<.001).


CONCLUSIONS
The significantly higher detection rate in mesenteric venous blood emphasizes the importance of the filter function of the liver for circulating tumor cells in portal venous blood. Tumor cell detection in central and peripheral venous blood, however, shows that this filtering process is limited and indicates early systemic hematogenic tumor cell dissemination in colorectal cancer.
Koch
M
M
Division for Molecular Diagnostics and Therapy, Department of Surgery, University of Heidelberg, INF 110, D-69120 Heidelberg, Germany.
Weitz
J
J
Kienle
P
P
Benner
A
A
Willeke
F
F
Lehnert
T
T
Herfarth
C
C
von Knebel Doeberitz
M
M
D014408:Biomarkers, Tumor; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D005260:Female; D006801:Humans; D007381:Intermediate Filament Proteins; D053554:Keratin-20; D008099:Liver / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013152:Splanchnic Circulation
D014408:Biomarkers, Tumor; D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; D053554:Keratin-20