Prognostic significance of prospectively detected bone marrow micrometastases in esophagogastric cancer: 10-year follow-up confirms prognostic significance.
We have previously reported that most patients with esophagogastric cancer (EGC) undergoing potentially curative resections have bone marrow micrometastases (BMM). We present 10-year outcome data of patients with EGC whose rib marrow was examined for micrometastases and correlate the findings with treatment and conventional pathologic tumor staging. A total of 88 patients with localized esophagogastric tumors had radical en-bloc esophagectomy, with 47 patients receiving neoadjuvant (5-fluorouracil/cisplatin based) chemoradiotherapy (CRT) and the remainder being treated with surgery alone. Rib marrow was examined for cytokeratin-18-positive cells. Standard demographic and pathologic features were recorded and patients were followed for a mean 10.04 years. Disease recurrences and all deaths in the follow-up period were recorded. No patients were lost to follow-up. 46 EGC-related and 10 non-EGC-related deaths occurred. Multivariate Cox analysis of interaction of neoadjuvant chemotherapy, nodal status, and BMM positivity showed that the contribution of BMM to disease-specific and overall survival is significant (P = 0.014). There is significant interaction with neoadjvant CRT (P < 0.005), and lymph node positivity (P < 0.001) but BMM positivity contributes to increase in risk of cancer-related death in patients treated with either CRT or surgery alone. Bone marrow micrometastases detected at the time of surgery for EGC is a long-term prognostic marker. Detection is a readily available, technically noncomplex test which offers a window on the metastatic process and a refinement of pathologic staging and is worthy of routine consideration.
Department of Pathology, Bon Secours Hospital, Cork, Ireland.|Cork Cancer Research Centre, University College Cork, Cork, Ireland.
Paul
P
Ryan
Royal College of Surgeons of Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland.
Heidi
H
Furlong
Department of Oncology, Bon Secours Hospital, Cork, Ireland.
Conleth G
CG
Murphy
School of Mathematical Sciences/Statistics, University College Cork, Cork, Ireland.
Finbarr
F
O'Sullivan
Royal College of Surgeons of Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland.
Thomas N
TN
Walsh
Department of Medicine, University College Cork, Cork, Ireland.
Fergus
F
Shanahan
Cork Cancer Research Centre, University College Cork, Cork, Ireland.|Department of Surgery, University College Cork, Cork, Ireland.
Gerald C
GC
O'Sullivan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D063868:Patient Outcome Assessment
10-year follow-up; bone marrow micrometastases; esophagogastric cancer