Occult Tumor Cells in Colorectal Cancer
Occult Tumor Cells in Colorectal Cancer
Steinert R, Hantschick M, Vieth M, et al
Arch Surg. 2008;143:122-128
What is the impact of occult tumor cell spread on survival of patients with colorectal cancer? In a group of 140 patients undergoing resectional surgery for colorectal cancer, the authors looked for occult tumor cells in lymph nodes where conventional node exam had been negative as well as occult tumor cells in the bone marrow and in peritoneal washings. After surgery the median follow-up period was 5 years. Out of 90 apparently node-negative patients, 41 were found to have lymph node micrometastasis; 89 of 140 patients had tumor cells in the bone marrow; 29 of 132 patients had free tumor cells within the peritoneal cavity. Only dissemination within the peritoneal cavity was associated with a marginal reduction in 5-year survival (P = .07).
This carefully designed study demonstrated that occult tumor cells are widely distributed in various locations after surgery for colorectal cancer. It is surprising that spread of tumor cells to the bone marrow does not have any impact on survival -- a finding that differs from bone marrow micrometastasis in breast cancer. Clinically significant bone metastatic disease is infrequent in colorectal cancer, compared with other cancers, such as metastasis of the liver. The results proved that most patients with colorectal cancer have disseminated disease at the time of surgery, and they indicated that the presence or absence of metastatic cancer cells is not a good predictor of cancer recurrence. However, the results might have been different if the follow-up period had been longer than 5 years.
Abstract
Steinert R, Hantschick M, Vieth M, et al
Arch Surg. 2008;143:122-128
What is the impact of occult tumor cell spread on survival of patients with colorectal cancer? In a group of 140 patients undergoing resectional surgery for colorectal cancer, the authors looked for occult tumor cells in lymph nodes where conventional node exam had been negative as well as occult tumor cells in the bone marrow and in peritoneal washings. After surgery the median follow-up period was 5 years. Out of 90 apparently node-negative patients, 41 were found to have lymph node micrometastasis; 89 of 140 patients had tumor cells in the bone marrow; 29 of 132 patients had free tumor cells within the peritoneal cavity. Only dissemination within the peritoneal cavity was associated with a marginal reduction in 5-year survival (P = .07).
This carefully designed study demonstrated that occult tumor cells are widely distributed in various locations after surgery for colorectal cancer. It is surprising that spread of tumor cells to the bone marrow does not have any impact on survival -- a finding that differs from bone marrow micrometastasis in breast cancer. Clinically significant bone metastatic disease is infrequent in colorectal cancer, compared with other cancers, such as metastasis of the liver. The results proved that most patients with colorectal cancer have disseminated disease at the time of surgery, and they indicated that the presence or absence of metastatic cancer cells is not a good predictor of cancer recurrence. However, the results might have been different if the follow-up period had been longer than 5 years.
Abstract
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