title: Prognostic impact of CK-20-positive cells in peripheral venous blood of patients with gastrointestinal carcinoma.
abstract: Despite curative tumor resection, about 30%-50% of patients with locally advanced gastrointestinal (GI) carcinoma develop tumor recurrence which may be caused by pre- or intraoperative tumor cell dissemination. We examined the combination of optimized density gradient centrifugation with a CK-20 reverse transcriptase-polymerase chain reaction to detect and quantify circulating tumor cells in peripheral blood. Peripheral venous blood (20 ml) of patients with GI carcinomas was collected during primary tumor staging before and after the endoscopy procedure. CK-20 expression in peripheral venous blood was found in 22 of 82 patients (26.8%) with a nonsignificant difference between the upper GI tract (23.9%) and the lower GI tract (30.5%). The correlation with clinical outcome (24-month-survival) revealed a significantly worse prognosis (p < 0.05) of CK-20-positive patients with carcinoma of the upper GI tract and a trend toward a worse prognosis for patients with carcinoma of the lower GI tract. Quantification of CK-20 expression in peripheral blood showed a significantly higher circulating CK-20 copy number (median: 2816) in patients with metastatic tumors than in those with non-metastatic tumors (median: 983) (p < 0.05). For a subset of 42 primarily operated patients, we correlated the detection rate with UICC (International Union Against Cancer) staging categories. In contrast to the upper GI tract, the detection rate of patients with carcinoma of the lower GI tract showed a trend toward tumor size (pT) and a significant correlation with the presence of distant metastases (pM) (p < 0.01) and the postoperative residual tumor status (R) (p < 0.01). The endoscopy procedure did not lead to an increased detection of CK-20 expression.
authors.affiliation: Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Chirurgisch-Onkologisches Labor K049. Ismaningerstr 22, 81675, Munich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Friederichs
authors.forename: Ralf
authors.initials: R
authors.lastname: Gertler
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenberg
authors.forename: Jörg
authors.initials: J
authors.lastname: Nahrig
authors.forename: Katrin
authors.initials: K
authors.lastname: Führer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzmann
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Dittler
authors.forename: Michael
authors.initials: M
authors.lastname: Dahm
authors.forename: Stefan
authors.initials: S
authors.lastname: Thorban
authors.forename: Hjalmar
authors.initials: H
authors.lastname: Nekarda
authors.forename: Jörg Rüdiger
authors.initials: JR
authors.lastname: Siewert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002499:Centrifugation, Density Gradient; D005770:Gastrointestinal Neoplasms / Q000097:blood*; D006801:Humans; D007381:Intermediate Filament Proteins / Q000378:metabolism*; D053554:Keratin-20; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000378:metabolism*; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; D053554:Keratin-20