title: Genetic detection of lymph node micrometastases: a selection criterion for liver transplantation in patients with liver metastases after colorectal cancer.
abstract: BACKGROUND
  Liver transplantation for nonresectable liver metastases from colorectal cancer was abandoned in 1994 on account of high recurrence rates. The aim of this study was to investigate whether the genetic detection of micrometastases in histologically negative lymph nodes of the primary colon cancer could be applied to select patients for liver transplantation.
  
  
  METHODS
  We analyzed 21 patients with colorectal cancer who had undergone liver transplantation between 1983 and 1994 for liver metastases. Eleven patients were histologically lymph node negative at the time of surgery; ten patients with lymph node metastases served as control group. DNA sequencing was used to screen tumor material for p53 and K-ras mutations. Mutant allele-specific amplification (MASA) was then used to search for micrometastases in DNA from regional lymph nodes of the primary colorectal cancer.
  
  
  RESULTS
  p53 and K-ras mutations were detected in 12 (57%) and 3 (14%) of 21 patients in the colorectal cancer, respectively. The mutations were confirmed in the corresponding liver metastases. Of 11 patients with histologically negative lymph nodes, nine were eligible for MASA due to presence of p53 or K-ras mutation. MASA revealed six of nine patients to be genetically positive for micrometastases. Three patients were both genetically and histologically negative. These three patients showed a significantly longer overall survival (P = 0.011) of 4, 5, and 20 years, respectively.
  
  
  CONCLUSIONS
  We conclude that the genetic detection of micrometastases by MASA could be a powerful prognostic indicator for selecting patients with colorectal liver metastases who could benefit from liver transplantation.
authors.affiliation: Department of Surgical Research, Medical University of Vienna, Vienna, Austria.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kappel
authors.forename: Daniela
authors.initials: D
authors.lastname: Kandioler
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
authors.forename: Friedrich
authors.initials: F
authors.lastname: Längle
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wrba
authors.forename: Martin
authors.initials: M
authors.lastname: Ploder
authors.forename: Gabriela
authors.initials: G
authors.lastname: Berlakovich
authors.forename: Thomas
authors.initials: T
authors.lastname: Soliman
authors.forename: Hubert
authors.initials: H
authors.lastname: Hetz
authors.forename: Susanne
authors.initials: S
authors.lastname: Rockenschaub
authors.forename: Erich
authors.initials: E
authors.lastname: Roth
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
mesh_terms: D000328:Adult; D001483:Base Sequence; D015179:Colorectal Neoplasms / Q000235:genetics / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics; D015996:Survival Rate; D016159:Tumor Suppressor Protein p53 / Q000235:genetics
chemical_list: D016159:Tumor Suppressor Protein p53; D016283:Proto-Oncogene Proteins p21(ras)