title: Prognostic value of cytokeratin-positive bone marrow cells of gastric cancer patients.
abstract: BACKGROUND
  Epithelial cells in the bone marrow of patients with gastric cancer suggest tumor dissemination; however, their prognostic implications are controversial. We prospectively evaluated the correlation of bone marrow findings, recurrence rate, and disease-free survival after long-term follow-up.
  
  
  METHODS
  Bone marrow were aspirated from both iliac crests and stained with monoclonal cytokeratin (CK)-18 antibody in 209 patients before their initial operation. Patients were followed up for a median of 56 months.
  
  
  RESULTS
  Overall, 39 (19%) of 209 patients and 15 (14%) of 109 R0-resected patients had CK-positive cells. CK-positive patients had more local, regional, and distant recurrence than CK-negative patients (P < .05). We found a significantly shorter disease-free survival (P < .05) in the patients with >2 CK-positive cells per 2 x 10(6) bone marrow cells (mean, 35 months) than in patients with <or=2 CK-positive cells per 2 x 10(6 )bone marrow cells (mean, 70 months) or in patients with no CK-positive cells (mean, 86 months). Multivariate analysis confirmed that >2 CK-positive cells per 2 x 10(6) bone marrow cells was an independent prognostic factor for tumor-related death (P < .05).
  
  
  CONCLUSIONS
  Not only the mere presence of CK-positive epithelial cells in bone marrow, but also the cell number, correlates with prognosis. Our findings suggest that classifying CK-positive bone marrow cells in these patients will facilitate future studies.
authors.affiliation: Department of Surgery and Surgical Oncology, Charité-Universitätsmedizin Berlin, Campus Buch, Robert-Rössle-Klinik at the Helios Klinikum Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gretschel
authors.forename: Christian
authors.initials: C
authors.lastname: Schick
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schneider
authors.forename: Lope
authors.initials: L
authors.lastname: Estevez-Schwarz
authors.forename: Andreas
authors.initials: A
authors.lastname: Bembenek
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000473:pathology*; D002452:Cell Count; D018572:Disease-Free Survival; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007150:Immunohistochemistry; D053538:Keratin-18 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*
chemical_list: D053538:Keratin-18