title: Detection of hematogenous tumor cell dissemination predicts tumor relapse in patients undergoing surgical resection of colorectal liver metastases.
abstract: OBJECTIVE
  To examine the prognostic significance of disseminated tumor cells in blood and bone marrow of patients undergoing surgical resection of colorectal liver metastases.
  
  
  BACKGROUND
  Despite curative hepatic resection of colorectal liver metastases, a high percentage of patients develop tumor recurrence. These recurrences probably originate from disseminated tumor cells released into the circulation before or during surgery.
  
  
  METHODS
  Thirty-seven patients with potentially curative (R0) resection of colorectal liver metastases were prospectively enrolled into the study. Preoperative bone marrow samples and preoperative, intraoperative, and postoperative blood samples were examined for disseminated tumor cells by CK20 RT-PCR.
  
  
  RESULTS
  Tumor cells were detected in preoperative blood samples in 11 of 37 (30%) patients, in intraoperative blood samples in 17 of 37 (46%) patients, and in postoperative blood samples in 8 of 37 (22%) patients. Four of 25 (16%) patients tested positive for disseminated tumor cells in bone marrow samples. Median follow-up time for all patients was 38 months (range, 10-63 months). Multivariate analysis confirmed tumor cell detection in intraoperative blood (P = 0.009) and in bone marrow samples (P = 0.013) to be independent prognostic factors of tumor relapse.
  
  
  CONCLUSIONS
  This is the first study demonstrating that detection of hematogenous tumor cell dissemination during hepatic resection of colorectal cancer metastases predicts tumor relapse. Detection of disseminated tumor cells may help to individualize adjuvant therapy for patients with colorectal liver metastases and to develop surgical strategies to prevent intraoperative hematogenous tumor cell shedding.
authors.affiliation: Department of Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Herfarth
authors.forename: Magnus
authors.initials: M
authors.lastname: von Knebel Doeberitz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007381:Intermediate Filament Proteins; D053554:Keratin-20; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; D053554:Keratin-20