title: Circulating cytokeratin-positive cells and tumor budding in colorectal cancer.
abstract: OBJECTIVE
  To investigate whether circulating cytokeratin-positive (CK+) cells in the mesenteric blood of resected colorectal specimens are prognostic and correlate with tumor budding.
  
  
  METHODS
  Fifty-six colorectal specimens were collected between 9/2007 and 7/2008. Blood from the mesenteric vein was drawn immediately after receiving the fresh and unfixed specimens in the pathology department. After separation of the mononuclear cells by Ficoll-Hypaque density-gradient centrifugation, cytological smears were immunocytochemically stained for CK18. Tumor budding was evaluated on slides stained for pan-cytokeratin. The identification of ≥ 30 buds/1.3 mm2was defined as high grade budding.
  
  
  RESULTS
  CK+cells and clusters were identified in 29 (48%) and 14 (25%) of the samples, respectively. Two cells were identified in one of three non-malignant cases. Clusters were found exclusively in malignant cases. The occurrence of CK+cells or clusters was not associated with any of the evaluated clinicopathological factors, including surgical technique and tumor budding. Moreover, the occurrence of CK+cells or clusters had no influence on the cancer-specific survival [75 mo (CI: 61; 88)vs83 mo (CI: 72; 95) and 80 mo (CI: 63; 98)vs79 mo (CI: 69; 89), respectively].
  
  
  CONCLUSIONS
  CK+cells and showed neither prognostic significance nor an association with tumor budding. It is very likely that CK18-staining is not specific enough to identify the relevant cells.
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Märkl
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Narjes
authors.initials: N
authors.lastname: Wilhelms
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Anthuber
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schenkirsch
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Schlimok
authors.affiliation: Bruno Märkl, Narjes Wilhelms, Institute of Pathology, Klinikum Augsburg, 86156 Augsburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oruzio
keywords: Circulating cells; Colorectal cancer; Peripheral blood; Survival; Tumor budding