title: Long-term follow-up of bladder cancer patients with disseminated tumour cells in bone marrow.
abstract: BACKGROUND
  The clinical relevance of polymerase chain reaction (PCR)-based techniques for detection of disseminated tumour cells (DTCs) in the bone marrow of bladder cancer (BCa) patients is still under debate, as data on long-term follow-up analysis have not yet been published.
  
  
  OBJECTIVE
  The aim of the present prospective study was to assess the prognostic significance of DTCs detected by cytokeratin-20 (CK20) reverse-transcriptase PCR in bone marrow from BCa patients undergoing radical cystectomy (RC).
  
  
  METHODS
  Bone marrow samples from 51 BCa patients with high-risk non-muscle-invasive or muscle-invasive urothelial carcinoma were drawn from the anterior iliac crest prior to RC. CK20-positive cells in bone marrow were detected by qualitative RT-PCR.
  
  
  METHODS
  BCa patients with CK20 status were analysed with respect to the end points tumour progression and cancer death. A multivariate Cox regression analysis was performed to determine independent prognostic factors for progression-free survival (PFS), tumour-specific survival (TSS), and overall survival (OS).
  
  
  CONCLUSIONS
  CK20-positive cells were detected in 16 of 51 (31.4%) BCa patients of all stages. BCa patients with CK20-negative status displayed a 7-yr PFS rate of 64% versus 35.2% for CK20-positive patients (p=0.007). TSS was significantly shorter in the CK20-positive group, with a 7-yr survival rate of 46.9% compared to CK20-negative patients with 70.2% (p=0.012). The 7-yr OS rate of 37.5% for CK20-positive patients was significantly <65.7% in the CK20-negative group (p=0.006). A subgroup analysis of lymph node-negative patients (pN0) discriminated by CK20 status revealed significant differences in PFS, TSS, and OS. In a multivariate analysis, CK20-status provides independent prognostic information with respect to all three survival end points.
  
  
  CONCLUSIONS
  BCa patients with positive CK20 status in bone marrow represent a high-risk subgroup reflected by an unfavourable outcome in the long-term analysis.
authors.affiliation: Department of Urology, Technische Universität München, Rechts der Isar Medical Centre, Munich, Germany. margitta.retz@lrz.tum.de
authors.forename: Margitta
authors.initials: M
authors.lastname: Retz
authors.forename: Jens
authors.initials: J
authors.lastname: Rotering
authors.forename: Roman
authors.initials: R
authors.lastname: Nawroth
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
authors.forename: Juergen E
authors.initials: JE
authors.lastname: Gschwend
authors.forename: Jan
authors.initials: J
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001856:Bone Marrow Examination; D019046:Bone Marrow Neoplasms / Q000235:genetics / Q000401:mortality / Q000556:secondary*; D002277:Carcinoma / Q000235:genetics / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D004273:DNA, Neoplasm / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D053554:Keratin-20 / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000628:therapy
chemical_list: D004273:DNA, Neoplasm; C507499:KRT20 protein, human; D053554:Keratin-20