title: Microscopic tumor cell dissemination in gastric cancer.
abstract: 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.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Mirko
authors.initials: M
authors.lastname: Weinrich
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
authors.forename: Hussein
authors.initials: H
authors.lastname: Al-Abadi
authors.forename: Roman
authors.initials: R
authors.lastname: Steinbrich
authors.forename: Cornelia
authors.initials: C
authors.lastname: Radke
authors.forename: Jochen
authors.initials: J
authors.lastname: Klupp
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: 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