Microscopic tumor cell dissemination in gastric cancer.
OBJECTIVE
There is still much controversy surrounding the prognostic significance of microscopic tumor cell dissemination in gastric cancer and its correlation with histopathologic parameters. We herein investigate such dissemination, predominantly restricted to the subserosa, in patients with gastric cancer.


METHODS
Intraoperative bone marrow aspiration was done in 26 patients undergoing resection of gastric carcinoma. Peritoneal lavage could not be done in 8 of these 26 patients. The R0-resection rate was 84% (n = 22). A cytokeratin-directed antibody and an antibody directed against carcinoembryonic antigen served for the immunocytochemical detection of tumor cells, and the alkaline phosphatase antialkaline phosphatase method was used for visualization.


RESULTS
The bone marrow aspirate and peritoneal lavage fluid were immunocytochemically positive in 31% and 56% of the patients, respectively. There was a trend (P = 0.10) towards higher overall survival rates in patients with negative bone marrow samples than in those with tumor cells detected in bone marrow samples. Analyzing the results of peritoneal lavage did not reveal any significant differences. In the group of T1/2 cancers, survival was significantly worse if the bone marrow was positive for tumor cells, with 3-year survival rates of 25% vs 77%, respectively (P < 0.05).


CONCLUSIONS
The rates of tumor cell dissemination into the bone marrow or into the peritoneal cavity were within the scope of previous reports. Dissemination into the bone marrow resulted in significantly impaired survival in patients with T1 and T2 gastric carcinoma, and it did not correlate with known prognostic parameters.
Jonas
Sven
S
Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany.
Weinrich
Mirko
M
Tullius
Stefan G
SG
Al-Abadi
Hussein
H
Steinbrich
Roman
R
Radke
Cornelia
C
Klupp
Jochen
J
Neuhaus
Peter
P
D001853:Bone Marrow / Q000473:pathology; D002277:Carcinoma / Q000401:mortality / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010533:Peritoneal Lavage; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis