Cancer Research and Treatment

Prognostic Significance of Lymph Node Micrometastasis in pT2N0 Gastric Cancer: Hyeon Kook Lee, Sam Je Cho, Yoon Ho Kim, Hye Seung Lee, Woo Ho Kim, Kuhn Uk Lee, Kuk Jin Choe, Jin Pok Kim, Han Kwang Yang; J Korean Cancer Assoc. 2001;33(2):130-135.

Abstract PDF: PURPOSE
The prognostic significance of lymph node (LN) micrometastasis in gastric cancer remains contro versial. We therefore investigated the clinicopathologic factors related to LN micrometastasis and evaluated the clinical relevance of micrometastasis with regard to urrence.
MATERIALS AND METHODS
A total of 1083 LNs from 39 patients with pT2N0 gastric cancer and who underwent curative resection in 1993 were further immunohistochemically stained using an anti-cytokeratin Ab cocktail (AE1-AE3).
RESULTS
Micrometastases were found in 3.9% (42/1083) of the resected LNs and 53.8% (21/39) of the patients with pT2N0 gastric cancer. LN micrometastasis was found to be significantly related with histologic differentiation. The recurrence rate of gastric cancer was higher in patients with LN micrometastasis (31.6%) than in those without (6.3%), with a borderline significance (p=0.074). In uni variate analysis, patients with LN micrometastasis had a shorter 5-year disease-free survival (65%) than those without LN micrometastasis (87%) (p=0.075). In multivariate analysis, multiple LN micrometastasis was associated with a poor prognosis, but with a borderline significance (p=0.069, Risk ratio 4.815) CONCLUSION: We were able to identify LN micrometastases missed on routine H-E staining, using an immuno histochemical technique. Our results suggest that LN micrometastasis is associated with the recurrence of pT2N0 gastric cancer.

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Detection of Circulating Tumor Cells in Peripheral Blood by Reverse Transcriptase - polymerase Chain Reaction in Gastric Cancer Patients: H Kim, Y Y Lee, T J Jeong, I Y Choi, I S Kim, D S Han, Y C Jeon, J H Sohn, W G Park, H G Paik, H G Lee, Y S Nam, M J Ahn; J Korean Cancer Assoc. 2000;32(2):304-311.

Abstract PDF: PURPOSE
Cancer cells can be detected in bloods, lymph nodes or bone marrows by using reverse transcriptase-polymerase chain reaction (RT-PCR). We investigated to detect carcinoembryonic antigen (CEA) mRNA in peripheral blood by RT-PCR as a circulating tumor cell maker of gastric cancer patients.
MATERIALS AND METHODS
Gastric cancer patients were early gastric cancer with curative surgery (Group A, n=9), advanced gastric cancer with curative surgery (Group B, n 18) and relapsed or metastatic gastric cancer (Group C, n=13). RT-PCR was performed to detect CEA mRNA expression in the peripheral blood mononuclear cells and we used Colo 201 cells as a positive control.
RESULTS
Seventeen patients (42.5%) were positive for CEA mRNA, whereas all the nine normal subjects were negative. There were significant differences between group A and C (p=0.041), group B and C (p=0.001) and between patients underwent curative surgery and metastatic gastric cancer patients (p 0.001) but not between A and B (p 0.326) for the positive rate of CEA mRNA.
CONCLUSION
Large number of gastric cancer patients showed positive CEA mRNA in peripheral blood suggesting that gastric cancer cells can metastasize into blood at early stage.

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The Significance of Bone Marrow Micrometastasis ( BMM ) in Breast Carcinoma: Su Hwan Kang, Soo Jung Lee, Sang Woon Kim, Koing Bo Kwun; J Korean Cancer Assoc. 2000;32(1):76-85.

Abstract PDF: PURPOSE
This study was performed to determine the incidence of BMM and to correlate the presence of these micrometastases with prognosis and othet clinicopathologic features.
Materials AND Methods
BMM was evaluated in 220 breast cancer patients between July, 1991 and January, 1997, using mouse monoclonal antibody (AE1/AE3) against cytokeratin in an immunofluorescent assay.
RESULTS
Of the 220 patients, 71 (32.3%) were positive for BMM. There were no association between bone marrow positivity and nodal status, TNM stage, known histopathologic parameters, and hormona1 receptor. Median follow-up for 220 patients was 41.6 month. The relapse rate was 16.8% (37/220). Twenty-four (33.8%) of 37 patients were positive for BMM and 13 (8.7%) were negative (p<0.05). Bone metastasis occurred in 16 cases, and was more common in BMM positive patients (14 of 24, 54.2%, versus 2 of 13, 15.4%, p < 0.05). Twenty-six patients were died of relapsed breast cancer. In overall survival, patients who was negative for BMM showed higher survival rate (p<0.05).
CONCLUSION
BMM was a good predictor for distant metastasis, especially bone metastasis, and for poor prognosis. But no association was found between bone marrow positivity and tumor size, nodal status, stage, histologic parameter and hormonal receptor status.

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Micrometastases of Axillary Lymph Nodes from Stage 2 a Breast Cancer : Immunohistochemical Detection and Prognostic Significance: Koo Jeong Kang, Hyung Tae Kim, Ki Yong Chung, You Sah Kim, Sang Han Lee, In Soo Suh; J Korean Cancer Assoc. 1996;28(5):819-829.

Abstract PDF: This study was performed to identify the cancer cells in lymph nodes taken from women stage IIa breast cancer using routine hematoxyline-eosin(HE) stains. Six hundred and thirty-four lymph nodes were taken from 42 cases of breast cancer. Among these, 31 cases were negative for lymph nodes metastasis and 1l were positive for lymph node metastasis. All 634 lymph nodes were immunostained. Eight of 11 patients(72.7%) who had positive lymph nodes had at least one or more nodes stained by anti-epithelial membrane antibody and 7 of ll patients(63.6%) who had positive nodes had at least one or more nodes stained by anti-cytokeratin(PAN-CK) anti-body. Of the 31 cases of negative lymph nodes, 2 cases of occult micrometastases were detected by immunohistochemical stains. One of the 2 cases was stained by only one monoclonal antibody In the follow up study(a mean of 59.9 months), there were no important prognostic factors for 5 year survival rates according to the following 3 categories: age( < 40 years vs. >=40 years), tumor size(< 2.0cm vs. >=2.0cm), and immunohistochemical stain. The presence of metastatic axillary lymph node was the most important prognostic factor for 5 year disease free survival(p=0.05). The immunohistochemical stain of the axillary lymph nodes was not significant for 5 year overall and disease free survival. One of the 2 patients who had negative axillary nodes by HE stain but positive nodes by immunohistochemical stains had a recurrence within 4 years and 11 months after mastectomy. Immunohistochemical stain for axillary lymph nodes of patients without lymph node metastases is a useful tool for detecting occult micrometastases, however, it is not helpful as a prognostic factor.

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