title: Prognostic Role of a Multimarker Analysis of Circulating Tumor Cells in Advanced Gastric and Gastroesophageal Adenocarcinomas.
abstract: OBJECTIVE
  We aimed to assess the prognostic value of circulating tumor cells (CTC) in patients with advanced gastric and gastroesophageal adenocarcinomas.
  
  
  METHODS
  The presence of CTC was evaluated in 62 patients with advanced gastric and gastroesophageal adenocarcinomas before systemic therapy and at follow-up through immunomagnetic enrichment for mucin 1- and epithelial cell adhesion molecule (EpCAM)-positive cells, followed by real-time RT-PCR of the tumor-associated genes KRT19, MUC1, EPCAM, CEACAM5 and BIRC5.
  
  
  RESULTS
  The patients were stratified into groups according to CTC detection (CTC negative: with all marker genes negative; CTC positive: with at least 1 of the marker genes positive). Patients who were CTC positive at baseline had a significantly shorter median progression-free survival (PFS; 3.5 months, 95% CI: 2.9-4.2) and overall survival (OS; 5.8 months, 95% CI: 4.5-7.0) than patients lacking CTC (PFS 10.7 months, 95% CI: 6.9-14.4, p<0.001; OS 13.3 months, 95% CI: 8.0-18.6, p=0.003). Alterations in the marker profile during the course of chemotherapy were not predictive of clinical outcome or response to therapy. Yet, a favorable clinical response depended significantly on CTC negativity (p=0.03).
  
  
  CONCLUSIONS
  Our data suggest that the presence of CTC is a major predictor of outcome in patients with gastric and gastroesophageal malignancies.
authors: Department of Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, Metabolic Disorders, Oncology, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
authors: Ilja
authors: I
authors: Kubisch
authors: Andreia
authors: A
authors: de Albuquerque
authors: Detlef
authors: D
authors: Schuppan
authors: Sepp
authors: S
authors: Kaul
authors: Markus
authors: M
authors: Schaich
authors: Ulrich
authors: U
authors: Stölzel
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000378:metabolism; D018572:Disease-Free Survival; D000071858:Epithelial Cell Adhesion Molecule; D004938:Esophageal Neoplasms / Q000097:blood / Q000378:metabolism / Q000473:pathology*; D005260:Female; D058851:GPI-Linked Proteins / Q000378:metabolism; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D009360:Neoplastic Cells, Circulating / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000097:blood* / Q000378:metabolism / Q000473:pathology*; D000077022:Survivin
chemical_list: D000951:Antigens, Neoplasm; C107489:BIRC5 protein, human; D014408:Biomarkers, Tumor; C527875:CEACAM5 protein, human; D002272:Carcinoembryonic Antigen; D015815:Cell Adhesion Molecules; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule; D058851:GPI-Linked Proteins; D051034:Inhibitor of Apoptosis Proteins; D018396:Mucin-1; D000077022:Survivin