Open AccessPrognostic significance of prospectively detected bone marrow micrometastases in esophagogastric cancer: 10‐year follow‐up confirms prognostic significance
Author(s) -
Ryan Paul,
Furlong Heidi,
Murphy Conleth G.,
O'Sullivan Finbarr,
Walsh Thomas N.,
Shanahan Fergus,
O'Sullivan Gerald C.
Publication year - 2015
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.470
Subject(s) - medicine , chemoradiotherapy , bone marrow , esophageal cancer , lymph node , esophagectomy , chemotherapy , oncology , proportional hazards model , cancer , gastroenterology , surgery
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.