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Bartkowiak K, Mossahebi Mohammadi P, Gärtner S, Kwiatkowski M, Andreas A, Geffken M, Peine S, Verpoort K, Scholz U, Deutsch TM, Michel LL, Schneeweiss A, Thewes V, Trumpp A, Müller V, Riethdorf S, Schlüter H, Pantel K. Detection and Isolation of Circulating Tumor Cells from Breast Cancer Patients Using CUB Domain-Containing Protein 1. J Proteome Res 2023; 22:1213-1230. [PMID: 36926972 DOI: 10.1021/acs.jproteome.2c00739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
In cancer metastasis, single circulating tumor cells (CTCs) in the blood and disseminated tumor cells (DTCs) in the bone marrow mediate cancer metastasis. Because suitable biomarker proteins are lacking, CTCs and DTCs with mesenchymal attributes are difficult to isolate from the bulk of normal blood cells. To establish a procedure allowing the isolation of such cells, we analyzed the cell line BC-M1 established from DTCs in the bone marrow of a breast cancer patient by stable isotope labeling by amino acids in cell culture (SILAC) and mass spectrometry. We found high levels of the transmembrane protein CUB domain-containing protein 1 (CDCP1) in breast cancer cell lines with mesenchymal attributes. Peripheral blood mononuclear cells were virtually negative for CDCP1. Confirmation in vivo by CellSearch revealed CDCP1-positive CTCs in 8 of 30 analyzed breast cancer patients. Only EpCam-positive CTCs were enriched by CellSearch. Using the extracellular domain of CDCP1, we established a magnetic-activated cell sorting (MACS) approach enabling also the enrichment of EpCam-negative CTCs. Thus, our approach is particularly suited for the isolation of mesenchymal CTCs with downregulated epithelial cancer that occur, for example, in triple-negative breast cancer patients who are prone to therapy failure.
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Affiliation(s)
- Kai Bartkowiak
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Parinaz Mossahebi Mohammadi
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sebastian Gärtner
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marcel Kwiatkowski
- Laboratory for Metabolic Signaling, Institute of Biochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria
| | - Antje Andreas
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Maria Geffken
- Department of Transfusion Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sven Peine
- Department of Transfusion Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Karl Verpoort
- Practice for Haematology and Oncology, Hohe Weide 17b, 20295 Hamburg, Germany
| | - Ursula Scholz
- Gynecological Oncology, Asklepios Klinik Hamburg-Barmbek, Rübenkamp 220, 22307 Hamburg, Germany
| | - Thomas M Deutsch
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Verena Thewes
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andreas Trumpp
- Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ) and DKFZ-ZMBH Alliance, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sabine Riethdorf
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Hartmut Schlüter
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Klaus Pantel
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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2
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Ac Kar L, Casjens S, Andreas A, Raiko I, Brüning T, Geffken M, Peine S, Kollmeier J, Johnen G, Bartkowiak K, Weber DG, Pantel K. Blood-based detection of lung cancer using cysteine-rich angiogenic inducer 61 (CYR61) as a circulating protein biomarker: a pilot study. Mol Oncol 2021; 15:2877-2890. [PMID: 34510714 PMCID: PMC8564649 DOI: 10.1002/1878-0261.13099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
Lung cancer is the most often diagnosed cancer and the main cause of cancer deaths in the world compared with other tumor entities. To date, the only screening method for high‐risk lung cancer patients is low‐dosed computed tomography which still suffers from high false‐positive rates and overdiagnosis. Therefore, there is an obvious need to identify biomarkers for the detection of lung cancer that could be used to guide the use of low‐dosed computed tomography or other imaging procedures. We aimed to assess the performance of the protein cysteine‐rich angiogenic inducer 61 (CYR61) as a circulating biomarker for the detection of lung cancer. CYR61 concentrations in plasma were significantly elevated in 87 lung cancer patients (13.7 ± 18.6 ng·mL−1) compared with 150 healthy controls (0.29 ± 0.22 ng·mL−1). Subset analysis stratified by sex revealed increased CYR61 concentrations for adenocarcinoma and squamous cell carcinoma in men compared with women. For male lung cancer patients versus male healthy controls, the sensitivity was 84% at a specificity of 100%, whereas for females, the sensitivity was 27% at a specificity of 99%. The determination of circulating CYR61 protein in plasma might improve the detection of lung cancer in men. The findings of this pilot study support further verification of CYR61 as a biomarker for lung cancer detection in men. Additionally, CYR61 is significantly elevated in women but sensitivity and specificity for CYR61 are too low for the improvement of the detection of lung cancer in women.
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Affiliation(s)
- Lucija Ac Kar
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Germany
| | - Swaantje Casjens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
| | - Antje Andreas
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Germany
| | - Irina Raiko
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
| | - Maria Geffken
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Sven Peine
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Jens Kollmeier
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
| | - Kai Bartkowiak
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniel Gilbert Weber
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Germany
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3
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Interleukin-6 trans-signaling is a candidate mechanism to drive progression of human DCCs during clinical latency. Nat Commun 2020; 11:4977. [PMID: 33020483 PMCID: PMC7536220 DOI: 10.1038/s41467-020-18701-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
Although thousands of breast cancer cells disseminate and home to bone marrow until primary surgery, usually less than a handful will succeed in establishing manifest metastases months to years later. To identify signals that support survival or outgrowth in patients, we profile rare bone marrow-derived disseminated cancer cells (DCCs) long before manifestation of metastasis and identify IL6/PI3K-signaling as candidate pathway for DCC activation. Surprisingly, and similar to mammary epithelial cells, DCCs lack membranous IL6 receptor expression and mechanistic dissection reveals IL6 trans-signaling to regulate a stem-like state of mammary epithelial cells via gp130. Responsiveness to IL6 trans-signals is found to be niche-dependent as bone marrow stromal and endosteal cells down-regulate gp130 in premalignant mammary epithelial cells as opposed to vascular niche cells. PIK3CA activation renders cells independent from IL6 trans-signaling. Consistent with a bottleneck function of microenvironmental DCC control, we find PIK3CA mutations highly associated with late-stage metastatic cells while being extremely rare in early DCCs. Our data suggest that the initial steps of metastasis formation are often not cancer cell-autonomous, but also depend on microenvironmental signals. Metastatic dissemination in breast cancer patients occurs early in malignant transformation, raising questions about how disseminated cancer cells (DCC) progress at distant sites. Here, the authors show that DCCs in bone marrow are activated via IL6-trans-signaling and thereby acquire stemness traits relevant for metastasis formation.
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4
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In Vitro Modeling of Reoxygenation Effects on mRNA and Protein Levels in Hypoxic Tumor Cells upon Entry into the Bloodstream. Cells 2020; 9:cells9051316. [PMID: 32466213 PMCID: PMC7291257 DOI: 10.3390/cells9051316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Solid epithelial tumors like breast cancer are the most frequent malignancy in women. Circulating tumor cells (CTCs) are frequently released from hypoxic areas into the blood, where CTCs face elevated oxygen concentrations. This reoxygenation might challenge the use of CTCs for liquid biopsy. Methods: We modeled this situation in vitro using the breast cancer cell lines—MCF-7, MDA-MB-468, MDA-MB-231—and the cell line BC-M1 established from DTCs in the bone marrow. Cells were cultured under hypoxia, followed by a reoxygenation pulse for 4 h, reflecting the circulation time of CTCs. Analyzed were gene products like EGFR, ErbB-2, EpCAM, PD-L1 on mRNA and protein level. Results: mRNAs of erbb2 or pdl1 and protein levels of PD-L1 displayed significant changes, whereas ErbB-2 protein levels remained constant. The strongest discrepancy between protein and mRNA levels under hypoxia was observed for EGFR, supporting the idea of cap-independent translation of egfr mRNA. Analyses of the phosphorylation of AKT, Erk 1/2, and Stat3 revealed strong alterations after reoxygenation. Conclusions: CTCs reaching secondary sites faster than reoxygenation could alter the mRNA and protein levels in the cells. CTC and DTC with high PD-L1 levels might become quiescent under hypoxia but were easily reactivated by reoxygenation.
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5
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Vargas G, Bouchet M, Bouazza L, Reboul P, Boyault C, Gervais M, Kan C, Benetollo C, Brevet M, Croset M, Mazel M, Cayrefourcq L, Geraci S, Vacher S, Pantano F, Filipits M, Driouch K, Bieche I, Gnant M, Jacot W, Aubin JE, Duterque-Coquillaud M, Alix-Panabières C, Clézardin P, Bonnelye E. ERRα promotes breast cancer cell dissemination to bone by increasing RANK expression in primary breast tumors. Oncogene 2019; 38:950-964. [PMID: 30478447 DOI: 10.1038/s41388-018-0579-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/20/2018] [Indexed: 02/07/2023]
Abstract
Bone is the most common metastatic site for breast cancer. Estrogen-related-receptor alpha (ERRα) has been implicated in cancer cell invasiveness. Here, we established that ERRα promotes spontaneous metastatic dissemination of breast cancer cells from primary mammary tumors to the skeleton. We carried out cohort studies, pharmacological inhibition, gain-of-function analyses in vivo and cellular and molecular studies in vitro to identify new biomarkers in breast cancer metastases. Meta-analysis of human primary breast tumors revealed that high ERRα expression levels were associated with bone but not lung metastases. ERRα expression was also detected in circulating tumor cells from metastatic breast cancer patients. ERRα overexpression in murine 4T1 breast cancer cells promoted spontaneous bone micro-metastases formation when tumor cells were inoculated orthotopically, whereas lung metastases occurred irrespective of ERRα expression level. In vivo, Rank was identified as a target for ERRα. That was confirmed in vitro in Rankl stimulated tumor cell invasion, in mTOR/pS6K phosphorylation, by transactivation assay, ChIP and bioinformatics analyses. Moreover, pharmacological inhibition of ERRα reduced primary tumor growth, bone micro-metastases formation and Rank expression in vitro and in vivo. Transcriptomic studies and meta-analysis confirmed a positive association between metastases and ERRα/RANK in breast cancer patients and also revealed a positive correlation between ERRα and BRCA1mut carriers. Taken together, our results reveal a novel ERRα/RANK axis by which ERRα in primary breast cancer promotes early dissemination of cancer cells to bone. These findings suggest that ERRα may be a useful therapeutic target to prevent bone metastases.
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Affiliation(s)
- G Vargas
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - M Bouchet
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
- IGFL, Lyon, France
| | - L Bouazza
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - P Reboul
- UMR7365-CNRS-Université de Lorraine, Nancy, France
| | - C Boyault
- Institute for Advanced Biosciences, Grenoble, France
| | - M Gervais
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - C Kan
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
- Center for Cancer Research, University of Sydney, Sydney, Australia
| | - C Benetollo
- University of Lyon1, Lyon, France
- INSERM-U1028-CNRS-UMR5292, Lyon, France
| | - M Brevet
- INSERM-UMR1033, Lyon, France
- Centre de Biologie et de Pathologie Est, Bron, France
| | - M Croset
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - M Mazel
- EA2415-Institut Universitaire de Recherche Clinique, Montpellier, France
| | - L Cayrefourcq
- EA2415-Institut Universitaire de Recherche Clinique, Montpellier, France
| | - S Geraci
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - S Vacher
- Department of Genetics, Institut-Curie, Paris, France
| | - F Pantano
- University-Campus-Bio-Medico, Rome, 00128, Italy
| | - M Filipits
- Department of Surgery and Comprehensive Cancer Center, Medical-University of Vienna, Vienna, Austria
| | - K Driouch
- Department of Genetics, Institut-Curie, Paris, France
| | - I Bieche
- Department of Genetics, Institut-Curie, Paris, France
| | - M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical-University of Vienna, Vienna, Austria
| | - W Jacot
- Montpellier Cancer Institute, Montpellier, France
| | - J E Aubin
- University of Toronto, Toronto, Canada
| | | | - C Alix-Panabières
- EA2415-Institut Universitaire de Recherche Clinique, Montpellier, France
| | - P Clézardin
- INSERM-UMR1033, Lyon, France
- University of Lyon1, Lyon, France
| | - E Bonnelye
- INSERM-UMR1033, Lyon, France.
- University of Lyon1, Lyon, France.
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6
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Croset M, Pantano F, Kan CWS, Bonnelye E, Descotes F, Alix-Panabières C, Lecellier CH, Bachelier R, Allioli N, Hong SS, Bartkowiak K, Pantel K, Clézardin P. miRNA-30 Family Members Inhibit Breast Cancer Invasion, Osteomimicry, and Bone Destruction by Directly Targeting Multiple Bone Metastasis-Associated Genes. Cancer Res 2018; 78:5259-5273. [PMID: 30042152 DOI: 10.1158/0008-5472.can-17-3058] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 05/10/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022]
Abstract
miRNAs are master regulators of gene expression that play key roles in cancer metastasis. During bone metastasis, metastatic tumor cells must rewire their biology and express genes that are normally expressed by bone cells (a process called osteomimicry), which endow tumor cells with full competence for outgrowth in the bone marrow. Here, we establish miR-30 family members miR-30a, miR-30b, miR-30c, miR-30d, and miR-30e as suppressors of breast cancer bone metastasis that regulate multiple pathways, including osteomimicry. Low expression of miR-30 in primary tumors from patients with breast cancer were associated with poor relapse-free survival. In addition, estrogen receptor (ER)-negative/progesterone receptor (PR)-negative breast cancer cells expressed lower miR-30 levels than their ER/PR-positive counterparts. Overexpression of miR-30 in ER/PR-negative breast cancer cells resulted in the reduction of bone metastasis burden in vivoIn vitro, miR-30 did not affect tumor cell proliferation, but did inhibit tumor cell invasion. Furthermore, overexpression of miR-30 restored bone homeostasis by reversing the effects of tumor cell-conditioned medium on osteoclastogenesis and osteoblastogenesis. A number of genes associated with osteoclastogenesis stimulation (IL8, IL11), osteoblastogenesis inhibition (DKK-1), tumor cell osteomimicry (RUNX2, CDH11), and invasiveness (CTGF, ITGA5, ITGB3) were identified as targets for repression by miR-30. Among these genes, silencing CDH11 or ITGA5 in ER-/PR-negative breast cancer cells recapitulated inhibitory effects of miR-30 on skeletal tumor burden in vivo Overall, our findings provide evidence that miR-30 family members employ multiple mechanisms to impede breast cancer bone metastasis and may represent attractive targets for therapeutic intervention.Significance: These findings suggest miR-30 family members may serve as an effective means to therapeutically attenuate metastasis in triple-negative breast cancer. Cancer Res; 78(18); 5259-73. ©2018 AACR.
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Affiliation(s)
| | - Francesco Pantano
- INSERM, UMR_S1033, University Lyon 1, Lyon, France.,Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | - Françoise Descotes
- Service de Biochimie Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Nathalie Allioli
- Institut des Sciences Pharmaceutiques et Biologiques (ISPB)-Faculté de Pharmacie de Lyon, University Claude Bernard Lyon 1. Centre de Recherche en Cancérologie de Lyon, Inserm U1052, CNRS UMR5286, Lyon, France
| | - Saw-See Hong
- University Lyon 1, UMR 754-INRA-EPHE, Lyon, France
| | - Kai Bartkowiak
- Department of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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7
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Messaritakis I, Politaki E, Koinis F, Stoltidis D, Apostolaki S, Plataki M, Dermitzaki EK, Georgoulias V, Kotsakis A. Dynamic changes of phenotypically different circulating tumor cells sub-populations in patients with recurrent/refractory small cell lung cancer treated with pazopanib. Sci Rep 2018; 8:2238. [PMID: 29396560 PMCID: PMC5797076 DOI: 10.1038/s41598-018-20502-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/17/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of the study was to investigate the effect of 2nd-line pazopanib on the different CTCs subpopulations in SCLC patients and evaluate the clinical relevance of their changes. Different CTCs subpopulations were evaluated before pazopanib initiation (n = 56 patients), after one-cycle (n = 35) and on disease progression (n = 45) by CellSearch and double immunofluorescence using anti-CKs and anti-Ki67, anti-M30 or anti-Vimentin antibodies. Before treatment, CTCs were detected in 50% of patients by CellSearch whereas 53.4%, 15.5% and 74.1% patients had CK+/Ki67+, CK+/M30+ and CK+/Vim+ CTCs, respectively. One pazopanib cycle significantly decreased the number of CTCs as detected by CellSearch (p = 0.043) as well as the number of CK+/Ki67+ (p < 0.001), CK+/M30+ (p = 0.015) and CK+/Vim+ (p < 0.001) cells. On disease progression, both the incidence and CTC numbers were significantly increased (CellSearch, p = 0.027; CK+/Ki67+, p < 0.001; CK+/M30+, p = 0.001 and CK+/Vim+, p < 0.001). In multivariate analysis, the detection of CK+/Vim+ CTCs after one treatment cycle (HR: 7.9, 95% CI: 2.9–21.8; p < 0.001) and CTCs number on disease progression, as assessed by CellSearch, (HR: 2.0, 95% CI: 1.0–6.0; p = 0.005) were emerged as independent factors associated with decreased OS. In conclusion, pazopanib can eliminate different CTC subpopulations in patients with relapsed SCLC. The analysis of CTCs could be used as a dynamic biomarker of treatment efficacy.
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Affiliation(s)
- Ippokratis Messaritakis
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eleni Politaki
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Fillipos Koinis
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Dimitris Stoltidis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - Stella Apostolaki
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Maria Plataki
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Vassilis Georgoulias
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece. .,Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece.
| | - Athanasios Kotsakis
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
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8
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Youn GJ, Chung WC. [Micrometastasis in Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 69:270-277. [PMID: 28539031 DOI: 10.4166/kjg.2017.69.5.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the incidence and mortality rate of gastric cancer have been steadily declining, gastric cancer is still the fourth most common cancer in the world and more than 50% of cases occur in Eastern Asia. In Korea, gastric cancer is the second most common cancer and third cause of cancer related death. The standard surgical procedure for resectable advanced gastric cancer is D2 lymphadenectomy with radical gastrectomy. Even though R0 resection was completed, recurrence is relatively common, and contributes to the limited survival of the patients in gastric cancer. As a clinically relevant factor for detection of the recurrence, the presence of isolating tumor cells has been introduced and it is so called as 'micrometastasis'. Numerous immunohistochemistry and molecular studies have shown that micrometastasis can be demonstrated not only in lymph nodes but also in such body compartments as the bone marrow, peritoneal cavity and blood. Herein, we review the current knowledge and evidence of the prognostic significance of micrometastasis in peritoneal, lymph node, bone marrow. Also, we discuss the current state of research on the circulating tumor cell in peripheral blood.
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Affiliation(s)
- Gun Jung Youn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Chul Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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9
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Yang J, Zhou Y, Zhao B. Isolation of circulating tumor cells in pancreatic cancer patients by immunocytochemical assay. J Clin Lab Anal 2017; 32. [PMID: 28523756 DOI: 10.1002/jcla.22156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/05/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The patients diagnosed with pancreatic cancer have the possibilities of getting the cancer again even after resection. The tumor cells identified from blood can be related to different stages of tumor. METHODS In this study, we used an immunoassay to detect circulating tumor cells in blood and bone marrow samples. About 120 patients' blood and bone marrow samples were used in this study along with controls. The presence of tumor cells was evaluated with different stages of cancer classified by UICC. The survival rate at each stages of tumor was also analyzed. RESULTS The tumor cells were isolated both in blood (29%) and bone marrow samples (25%). The prevalence of tumor cells increased with increase in stages of tumor in blood samples. CONCLUSION The survival of the patients considerably related to different stages of tumor but it cannot be taken a parameter alone for the patients' survival.
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Affiliation(s)
- Jing Yang
- Department of General Surgery, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Ying Zhou
- Department of Gastroenterology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Bin Zhao
- Department of General Surgery, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
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10
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Messaritakis I, Stoltidis D, Kotsakis A, Dermitzaki EK, Koinis F, Lagoudaki E, Koutsopoulos A, Politaki E, Apostolaki S, Souglakos J, Georgoulias V. TTF-1- and/or CD56-positive Circulating Tumor Cells in patients with small cell lung cancer (SCLC). Sci Rep 2017; 7:45351. [PMID: 28349943 PMCID: PMC5368597 DOI: 10.1038/srep45351] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to evaluate the phenotypic CTCs heterogeneity (TTF-1+ and/or CD56+) in SCLC patients and correlate it with the CellSearch. Peripheral blood was obtained from 108 consecutive patients. CTCs were detected by CellSearch and double-immunofluorescence using anti-CD45, anti-TTF-1 and anti-CD56 antibodies. Before chemotherapy TTF-1+/CD45−, CD56+/CD45− and TTF-1+/CD56+ CTCs were detected in 66(61.1%), 55(50.9%) and 46(42.6%) patients, respectively; 60.2% of patients were CellSearch+. Among the 22 patients with 0 CTCs/7.5 ml on CellSearch, TTF-1+/CD45−, CD56+/CD45− and TTF-1+/CD56+ CTCs were detected in 8(36.4%), 6(27.3) and 6(27.3%) patients, respectively; no CK+/EpCAM+ or TTF1+/EpCAM+ CTCs were detected in these patients. One-chemotherapy cycle decreased both the number of positive patients (p < 0.001) and their CTC number (p < 0.001), irrespectively of their phenotype and the detection method. The incidence and number of the different CTC subpopulations on PD, was significantly increased at their baseline levels. Multivariate analysis revealed that the increased number of CTCs at baseline and on PD were significantly associated with decreased PFS (p = 0.048) and OS (p = 0.041), respectively. There is an important CTC heterogeneity in such patients according to the expression of TTF-1 and CD56 which could detect EpCAM− CTC subpopulations and, thus, undetectable by CellSearch. These CTC subpopulations are dynamically correlated with treatment efficacy and disease-progression.
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Affiliation(s)
| | - Dimitris Stoltidis
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
| | - Athanasios Kotsakis
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece.,Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | | | - Fillipos Koinis
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
| | - Eleni Lagoudaki
- Pathology, University General Hospital of Heraklion, Crete, Greece
| | | | - Eleni Politaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
| | - Stella Apostolaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
| | - John Souglakos
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece.,Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - Vassilis Georgoulias
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
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11
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Messaritakis I, Politaki E, Plataki M, Karavassilis V, Kentepozidis N, Koinis F, Samantas E, Georgoulias V, Kotsakis A. Heterogeneity of circulating tumor cells (CTCs) in patients with recurrent small cell lung cancer (SCLC) treated with pazopanib. Lung Cancer 2017; 104:16-23. [DOI: 10.1016/j.lungcan.2016.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022]
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12
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Epithelial-mesenchymal plasticity in circulating tumor cells. J Mol Med (Berl) 2016; 95:133-142. [DOI: 10.1007/s00109-016-1500-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/06/2016] [Accepted: 12/08/2016] [Indexed: 12/18/2022]
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13
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Functional studies on circulating and disseminated tumor cells in carcinoma patients. Mol Oncol 2016; 10:443-9. [PMID: 26847851 DOI: 10.1016/j.molonc.2016.01.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/04/2016] [Indexed: 12/18/2022] Open
Abstract
Despite numerous clinical studies indicating the clinical relevance of circulating tumor cells (CTCs) in blood and disseminated tumor cells (DTCs) in the bone marrow of cancer patients, the functional properties of these cells are largely unknown. The focus of this review is to emphasize how functional studies on viable CTCs and DTCs can enlarge the spectrum of applications of "liquid biopsies". The low number of CTCs in the peripheral blood and DTCs in the bone marrow and the fact that carcinoma cells are difficult to culture are major challenges. Significant advances in the in vitro and in vivo expansion of CTCs and DTCs from cancer patients have been achieved, which enable us now to study the functional properties of these cells. Here, we discuss published data about functional studies on CTCs and DTCs using in vitro cultivation and in vivo xenograft models. Functional analyses on CTCs and DTCs offer the possibility to identify the metastasis-initiating cells. Moreover, CTC-derived cell lines and xenografts might point to new therapeutic targets and can be used for drug development.
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14
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Bartkowiak K, Kwiatkowski M, Buck F, Gorges TM, Nilse L, Assmann V, Andreas A, Müller V, Wikman H, Riethdorf S, Schlüter H, Pantel K. Disseminated Tumor Cells Persist in the Bone Marrow of Breast Cancer Patients through Sustained Activation of the Unfolded Protein Response. Cancer Res 2015; 75:5367-77. [PMID: 26573792 DOI: 10.1158/0008-5472.can-14-3728] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
Disseminated tumor cells (DTC), which share mesenchymal and epithelial properties, are considered to be metastasis-initiating cells in breast cancer. However, the mechanisms supporting DTC survival are poorly understood. DTC extravasation into the bone marrow may be encouraged by low oxygen concentrations that trigger metabolic and molecular alterations contributing to DTC survival. Here, we investigated how the unfolded protein response (UPR), an important cytoprotective program induced by hypoxia, affects the behavior of stressed cancer cells. DTC cell lines established from the bone marrow of patients with breast cancer (BC-M1), lung cancer, (LC-M1), and prostate cancer (PC-E1) were subjected to hypoxic and hypoglycemic conditions. BC-M1 and LC-M1 exhibiting mesenchymal and epithelial properties adapted readily to hypoxia and glucose starvation. Upregulation of UPR proteins, such as the glucose-regulated protein Grp78, induced the formation of filamentous networks, resulting in proliferative advantages and sustained survival under total glucose deprivation. High Grp78 expression correlated with mesenchymal attributes of breast and lung cancer cells and with poor differentiation in clinical samples of primary breast and lung carcinomas. In DTCs isolated from bone marrow specimens from breast cancer patients, Grp78-positive stress granules were observed, consistent with the likelihood these cells were exposed to acute cell stress. Overall, our findings provide the first evidence that the UPR is activated in DTC in the bone marrow from cancer patients, warranting further study of this cell stress pathway as a predictive biomarker for recurrent metastatic disease.
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Affiliation(s)
- Kai Bartkowiak
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marcel Kwiatkowski
- Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Buck
- Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias M Gorges
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Nilse
- Institute of Molecular Medicine and Cell Research, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Volker Assmann
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antje Andreas
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harriet Wikman
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartmut Schlüter
- Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Schwarzenbach H, Eichelser C, Steinbach B, Tadewaldt J, Pantel K, Lobanenkov V, Loukinov D. Differential regulation of MAGE-A1 promoter activity by BORIS and Sp1, both interacting with the TATA binding protein. BMC Cancer 2014; 14:796. [PMID: 25363021 PMCID: PMC4230356 DOI: 10.1186/1471-2407-14-796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/23/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND As cancer-testis MAGE-A antigens are targets for tumor immunotherapy, it is important to study the regulation of their expression in cancers. This regulation appears to be rather complex and at the moment controversial. Although it is generally accepted that MAGE-A expression is controlled by epigenetics, the exact mechanisms of that control remain poorly understood. METHODS We analyzed the interplay of another cancer-testis gene, BORIS, and the transcription factors Ets-1 and Sp1 in the regulation of MAGE-A1 gene expression performing luciferase assays, quantitative real-time PCR, sodium bisulfite sequencing, chromatin immunoprecipitation assays and pull down experiments. RESULTS We detected that ectopically expressed BORIS could activate and demethylate both endogenous and methylated reporter MAGE-A1 promoter in MCF-7 and micrometastatic BCM1 cancer cell lines. Overexpression of Ets-1 could not further upregulate the promoter activity mediated by BORIS. Surprisingly, in co-transfection experiments we observed that Sp1 partly repressed the BORIS-mediated stimulation, while addition of Ets-1 expression plasmid abrogated the Sp1 mediated repression of MAGE-A1 promoter. Both BORIS and Sp1 interacted with the TATA binding protein (hTBP) suggesting the possibility of a competitive mechanism of action between BORIS and Sp1. CONCLUSIONS Our findings show that BORIS and Sp1 have opposite effects on the regulation of MAGE-A1 gene expression. This differential regulation may be explained by direct protein-protein interaction of both factors or by interaction of MAGE-A1 promoter with BORIS alternatively spliced isoforms with different sequence specificity. We also show here that ectopic expression of BORIS can activate transcription from its own locus, inducing all its splice variants.
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Affiliation(s)
- Heidi Schwarzenbach
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany.
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16
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Joosse SA, Müller V, Steinbach B, Pantel K, Schwarzenbach H. Circulating cell-free cancer-testis MAGE-A RNA, BORIS RNA, let-7b and miR-202 in the blood of patients with breast cancer and benign breast diseases. Br J Cancer 2014; 111:909-17. [PMID: 24983365 PMCID: PMC4150270 DOI: 10.1038/bjc.2014.360] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/19/2014] [Accepted: 05/29/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND MAGE-A (melanoma-associated antigen-A) are promising targets for specific immunotherapy and their expression may be induced by the epigenetic factor BORIS. METHODS To determine their relevance for breast cancer, we quantified the levels of MAGE-A1, -A2, -A3, -A12 and BORIS mRNA, as well as microRNAs let-7b and miR-202 in pre- and postoperative serum of 102 and 34 breast cancer patients, respectively, and in serum of 26 patients with benign breast diseases and 37 healthy women by real-time PCR. The mean follow-up time of the cancer patients was 6.2 years. RESULTS The serum levels of MAGE-A and BORIS mRNA, as well as let-7b were significantly higher in patients with invasive carcinomas than in patients with benign breast diseases or healthy women (P<0.001), whereas the levels of miR-202 were elevated in both patient cohorts (P<0.001). In uni- and multivariate analyses, high levels of miR-202 significantly correlated with poor overall survival (P=0.0001). Transfection of breast cancer cells with synthetic microRNAs and their inhibitors showed that let-7b and miR-202 did not affect the protein expression of MAGE-A1. CONCLUSIONS Based on their cancer-specific increase in breast cancer patients, circulating MAGE-A and BORIS mRNAs may be further explored for early detection of breast cancer and monitoring of MAGE-directed immunotherapies. Moreover, serum miR-202 is associated with prognosis.
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Affiliation(s)
- S A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Müller
- Clinic of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Steinbach
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Schwarzenbach
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Zhao Y, Bao Q, Schwarz B, Zhao L, Mysliwietz J, Ellwart J, Renner A, Hirner H, Niess H, Camaj P, Angele M, Gros S, Izbicki J, Jauch KW, Nelson PJ, Bruns CJ. Stem Cell-Like Side Populations in Esophageal Cancer: A Source of Chemotherapy Resistance and Metastases. Stem Cells Dev 2014; 23:180-92. [DOI: 10.1089/scd.2013.0103] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yue Zhao
- Department of Surgery, University of Munich, Munich, Germany
- DKTK, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Qi Bao
- Department of Surgery, University of Munich, Munich, Germany
| | - Bettina Schwarz
- Department of Surgery, University of Munich, Munich, Germany
| | - Lu Zhao
- Department of Surgery, University of Munich, Munich, Germany
| | - Josef Mysliwietz
- Institute of Molecular Immunology, Helmholtz Center for Environment and Health, Munich, Germany
| | - Joachim Ellwart
- Institute of Molecular Immunology, Helmholtz Center for Environment and Health, Munich, Germany
| | - Andera Renner
- Department of Surgery, University of Munich, Munich, Germany
| | - Heidrun Hirner
- Department of Surgery, University of Munich, Munich, Germany
| | - Hanno Niess
- Department of Surgery, University of Munich, Munich, Germany
| | - Peter Camaj
- Department of Surgery, University of Munich, Munich, Germany
| | - Martin Angele
- Department of Surgery, University of Munich, Munich, Germany
| | - Stephanie Gros
- Department of Surgery, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Izbicki
- Department of Surgery, University of Hamburg-Eppendorf, Hamburg, Germany
| | | | - Peter Jon Nelson
- Clinical Biochemistry Group, Medizinische Klinik und Policlinic IV, University of Munich, Munich, Germany
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18
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19
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Gros SJ. Orthotopic models of esophageal carcinoma and their use in drug discovery. ACTA ACUST UNITED AC 2012; Chapter 14:Unit14.20. [PMID: 21898333 DOI: 10.1002/0471141755.ph1420s54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The protocol detailed in this unit is for the establishment of an orthotopic model of human esophageal adenocarcinoma in NMRI/nu mice. The resultant tumor has high metastatic potential, spreading readily to liver, lungs, and lymph nodes. This model is useful for studying primary esophageal carcinoma, tumor biology, pathogenesis, tumor progression, metastatic homing, and the efficacy of therapeutic approaches for treating this condition. The practical use of this preclinical model for drug discovery is illustrated with data from a study on the chemotherapeutic effects of HER2-targeted therapy.
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Affiliation(s)
- Stephanie J Gros
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Distinct functional roles of Akt isoforms for proliferation, survival, migration and EGF-mediated signalling in lung cancer derived disseminated tumor cells. Cell Signal 2011; 23:1952-60. [DOI: 10.1016/j.cellsig.2011.07.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/04/2011] [Indexed: 02/07/2023]
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21
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Roth C, Kasimir-Bauer S, Pantel K, Schwarzenbach H. Screening for circulating nucleic acids and caspase activity in the peripheral blood as potential diagnostic tools in lung cancer. Mol Oncol 2011; 5:281-91. [PMID: 21398193 DOI: 10.1016/j.molonc.2011.02.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 01/15/2023] Open
Abstract
The focus of the current investigational study was to examine whether circulating nucleic acids (i.e., DNA and microRNAs) have the potential to become suitable blood-based markers for diagnosis and progression of lung cancer. The concentrations of cell-free DNA and four circulating microRNAs (miR10b, miR34a, miR141 and miR155) as well as the caspase activity were measured in serum of 35 lung cancer patients (19 non-small-cell lung cancer, 8 small cell lung cancer patients and 8 patients with indefinite cancer type), 7 patients with benign lung tumors and 28 healthy individuals by PicoGreen, TaqMan MicroRNA, and Caspase-Glo®3/7 assay, respectively. The data were correlated with the established risk factors for lung cancer progression. The concentrations of cell-free DNA (p = 0.0001), serum microRNAs (p = 0.0001) and caspase activities (p = 0.0001) significantly discriminated cancer patients from healthy individuals. Serum DNA, caspase activities and RNA levels could not distinguish between patients with benign lung disease and cancer patients. However, the levels of miR10b (p = 0.002), miR141 (p = 0.0001) and miR155 (p = 0.007) were significantly higher in lung cancer patients than those in patients with benign disease. As determined by the Spearman-Rho test, high levels of cell-free DNA significantly correlated with elevated circulating caspase activities (p = 0.0001). In lung cancer patients high serum miR10b values associated with lymph node metastasis (p < 0.03) and elevated levels of TPA (tissue polypeptide antigen, p = 0.01), whereas high serum miR141 values associated with elevated levels of uPA (urokinase plasminogen activator, p = 0.02). The findings of our pilot study suggest that the assays for circulating DNA, microRNAs and caspase activities in blood might become novel minimally invasive diagnostic tools for detection and risk assessment of lung cancer, provided that their clinical utility can be confirmed in larger prospective trials.
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Affiliation(s)
- Carina Roth
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Germany
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22
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Roth C, Rack B, Müller V, Janni W, Pantel K, Schwarzenbach H. Circulating microRNAs as blood-based markers for patients with primary and metastatic breast cancer. Breast Cancer Res 2010; 12:R90. [PMID: 21047409 PMCID: PMC3046429 DOI: 10.1186/bcr2766] [Citation(s) in RCA: 305] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/14/2010] [Accepted: 11/03/2010] [Indexed: 12/19/2022] Open
Abstract
Introduction MicroRNAs (miRs) are interesting new diagnostic targets that may provide important insights into the molecular pathogenesis of breast cancer. Here we evaluated, for the first time, the feasibility and clinical utility of circulating miRs as biomarkers for the detection and staging of breast cancer. Methods The relative concentrations of breast cancer-associated miR10b, miR34a, miR141 and miR155 were measured in the blood serum of 89 patients with primary breast cancer (M0, n = 59) and metastatic disease (M1, n = 30), and 29 healthy women by a TaqMan MicroRNA Assay. Results The relative concentrations of total RNA (P = 0.0001) and miR155 (P = 0.0001) in serum significantly discriminated M0-patients from healthy women, whereas miR10b (P = 0.005), miR34a (P = 0.001) and miR155 (P = 0.008) discriminated M1-patients from healthy controls. In breast cancer patients, the changes in the levels of total RNA (P = 0.0001), miR10b (P = 0.01), miR34a (P = 0.003) and miR155 (P = 0.002) correlated with the presence of overt metastases. Within the M0-cohort, patients at advanced tumor stages (pT3 to 4) had significantly more total RNA (P = 0.0001) and miR34a (P = 0.01) in their blood than patients at early tumor stages (pT1 to 2). Conclusions This pilot study provides first evidence that tumor-associated circulating miRs are elevated in the blood of breast cancer patients and associated with tumor progression.
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Affiliation(s)
- Carina Roth
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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23
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Bartkowiak K, Effenberger KE, Harder S, Andreas A, Buck F, Peter-Katalinic J, Pantel K, Brandt BH. Discovery of a Novel Unfolded Protein Response Phenotype of Cancer Stem/Progenitor Cells from the Bone Marrow of Breast Cancer Patients. J Proteome Res 2010; 9:3158-68. [DOI: 10.1021/pr100039d] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Kai Bartkowiak
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Katharina E. Effenberger
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Sönke Harder
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Antje Andreas
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Friedrich Buck
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Jasna Peter-Katalinic
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Burkhard H. Brandt
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
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Gros SJ, Dohrmann T, Peldschus K, Schurr PG, Kaifi JT, Kalinina T, Reichelt U, Mann O, Strate TG, Adam G, Hoffman RM, Izbicki JR. Complementary use of fluorescence and magnetic resonance imaging of metastatic esophageal cancer in a novel orthotopic mouse model. Int J Cancer 2010; 126:2671-81. [PMID: 19847813 DOI: 10.1002/ijc.24980] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe the development of an aggressive orthotopic metastatic model of esophageal cancer, which is visualized in real time with combined magnetic resonance imaging (MRI) and fluorescence imaging. The aim of the study was to describe the development of a novel model of metastatic tumor disease of esophageal carcinoma and use this model to evaluate fluorescence and MRI in early detection of local and metastatic disease. The human esophageal adenocarcinoma cell line PT1590 was stably transfected with green fluorescent protein (GFP). Nude mice were orthotopically implanted with PT1590-GFP cells. Orthotopic tumor growth as well as metastatic spread was examined by fluorescence imaging and high-resolution MRI at defined intervals after orthotopic implantation. Highly aggressive novel fluorescent cell lines were isolated from metastatic tissues and put into culture. After implantation of these cells, 100% of the animals developed orthotopic primary tumors. In 83% of animals, metastatic spread to liver, lung and lymph nodes was observed. Primary tumor growth could be visualized with fluorescence imaging and with MRI with high correlation between the 2 methods. Fluorescence imaging allows fast, sensitive, and economical imaging of the primary and metastatic tumor without anesthesia. With MRI, anatomical structures are visualized more precisely and tumors can be more accurately localized to specific organs. This model should prove highly useful to understand esophageal carcinoma and to identify novel therapeutics for this treatment-resistant disease.
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Affiliation(s)
- Stephanie J Gros
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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25
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Bartkowiak K, Wieczorek M, Buck F, Harder S, Moldenhauer J, Effenberger KE, Pantel K, Peter-Katalinic J, Brandt BH. Two-Dimensional Differential Gel Electrophoresis of a Cell Line Derived from a Breast Cancer Micrometastasis Revealed a Stem/Progenitor Cell Protein Profile. J Proteome Res 2009; 8:2004-14. [DOI: 10.1021/pr8009758] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kai Bartkowiak
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Marek Wieczorek
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Friedrich Buck
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Sönke Harder
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Jennifer Moldenhauer
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Katharina E. Effenberger
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Jasna Peter-Katalinic
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
| | - Burkhard H. Brandt
- Institute for Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Department of Plant Biochemistry and Biotechnology, Westphalian Wilhelm’s-University Münster, Hindenburgplatz 55, 48143 Münster, Germany, and Institute of Medical Physics and Biophysics, Westphalian Wilhelm’s-University Münster, Robert-Koch Str. 31, D-48149 Münster, Germany
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Trastuzumab decreases the number of circulating and disseminated tumor cells despite trastuzumab resistance of the primary tumor. Cancer Lett 2007; 260:198-208. [PMID: 18096313 DOI: 10.1016/j.canlet.2007.10.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 10/26/2007] [Accepted: 10/30/2007] [Indexed: 11/22/2022]
Abstract
We have recently shown that despite of the fact that the ErbB2-positive JIMT-1 human breast cancer cells intrinsically resistant to trastuzumab in vitro, trastuzumab inhibited the outgrowth of early phase JIMT-1 xenografts in SCID mice via antibody-dependent cellular cytotoxicity (ADCC). Here we show that trastuzumab significantly reduces the number of circulating and disseminated tumor cells (CTCs and DTCs) in this xenograft model system at a time when the primary tumor is already unresponsive to trastuzumab. This observation suggests that ErbB2 positive CTCs and DTCs might be sensitive to trastuzumab-mediated ADCC even if when the primary tumor is already non-responsive. Thus, trastuzumab treatment might also be beneficial in the case of patients with breast cancer that is already trastuzumab resistant.
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Kallergi G, Mavroudis D, Georgoulias V, Stournaras C. Phosphorylation of FAK, PI-3K, and impaired actin organization in CK-positive micrometastatic breast cancer cells. Mol Med 2007; 13:79-88. [PMID: 17515959 PMCID: PMC1869618 DOI: 10.2119/2006-00083.kallergi] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 12/12/2006] [Indexed: 12/12/2022] Open
Abstract
Several markers have been used to detect circulating tumor cells (CTC) in the peripheral blood of patients with breast cancer. However, analysis of activated signaling kinases in CTC implicated in cellular transformation, migration, and survival has not been addressed so far. In the present study, we focused on the phenotypic profile of micrometastatic cells in peripheral blood mononuclear cells (PBMC) preparations from 45 breast cancer patients. PBMC cytospins from 28 cytokeratin (CK)-positive and 17 CK-negative samples were assessed for the expression of phosphorylated FAK (p-FAK), phosphorylated PI-3 kinase (p-PI-3K), and HER2 using confocal laser scanning microscopy. The expression of p-FAK was documented in all 28 CK-positive samples, while all 17 CK-negative samples were tested negative for p-FAK. Immunomagnetic separation using EpCAM antibody fully confirmed these findings, implying a sound correlation for the co-expression of the two molecules. Interestingly, 15 of 28 CK- and p-FAK-positive samples also expressed the HER2 oncoprotein. p-PI-3K was documented in 15 of 17 CK- and p-FAK-positive samples. Immunoblot analysis of micrometastatic cells in co-culture with PBMC confirmed the specific expression of both p-FAK and p-PI-3K. Finally, impaired actin organization was apparent in CK- and p-FAK/p-PI-3K-positive samples, comparable to that observed in MCF-7 human breast cancer cells. Our findings provide strong evidence that micrometastatic cells express activated signaling kinases, which may regulate migration mechanisms, supporting the presumption of their malignant and metastatic nature.
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Affiliation(s)
- Galatea Kallergi
- Department of Biochemistry, University of Crete Medical School and
| | - Dimitris Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, 71110, Greece
| | - Vassilis Georgoulias
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, 71110, Greece
| | - Christos Stournaras
- Department of Biochemistry, University of Crete Medical School and
- Address correspondence and reprint requests to Christos Stournaras, Department of Biochemistry, University of Crete Medical School, GR-71110 Heraklion Voutes. Phone: +30-2810-394563; Fax: +30-2810-394530; E-mail:
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Oki E, Kakeji Y, Baba H, Nishida K, Koga T, Tokunaga E, Egashira A, Ikeda K, Yoshida R, Yamamoto M, Morita M, Maehara Y. Clinical significance of cytokeratin positive cells in bone marrow of gastric cancer patients. J Cancer Res Clin Oncol 2007; 133:995-1000. [PMID: 17588173 DOI: 10.1007/s00432-007-0258-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 06/05/2007] [Indexed: 11/25/2022]
Abstract
Bone marrow (BM) is a prognostically relevant indicator organ of micrometastasis; however, the clinical importance of BM micrometastasis in gastric cancer patients is not yet known. In the present study, the BM of 267 consecutive patients with primary gastric cancer was examined for tumor cells using immunocytochemical techniques. Real-time quantitative RT-PCR was used to ensure that the tumor cells were detected properly. Among the 267 cases analyzed, 30 cases (11.2%) had cytokeratin-positive cells in the bone marrow. Positive findings were related to the tumor stage (P<0.05) and to the prominent depth of invasion (P<0.05). All patients with liver metastasis at operation had cytokeratin-positive cells in the BM. Recurrence of the disease was confirmed in 50 cases (18.7%); 4 of 30 (13.3%) in the cytokeratin-positive group and 46 of 237 (19.4%) in the cytokeratin-negative group. There were no significant differences in the 5-year survival rates between the cytokeratin-positive and cytokeratin-negative groups. Our study shows that BM micrometastasis increases according to tumor progression; however, only a subset of cancer cells may survive in the BM and finally evolve to a clinically apparent disease. Therefore it does not accurately predict the prognosis or recurrence of the disease.
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Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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29
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Apostolaki S, Perraki M, Pallis A, Bozionelou V, Agelaki S, Kanellou P, Kotsakis A, Politaki E, Kalbakis K, Kalykaki A, Vamvakas L, Georgoulias V, Mavroudis D. Circulating HER2 mRNA-positive cells in the peripheral blood of patients with stage I and II breast cancer after the administration of adjuvant chemotherapy: evaluation of their clinical relevance. Ann Oncol 2007; 18:851-8. [PMID: 17301075 DOI: 10.1093/annonc/mdl502] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of circulating tumor cells (CTCs) expressing HER2 messenger RNA (mRNA) after the administration of adjuvant chemotherapy in women with operable breast cancer. PATIENTS AND METHODS HER2 mRNA-positive CTCs were detected by nested RT-PCR in the peripheral blood of 214 patients with stage I and II breast cancer after the completion of adjuvant chemotherapy. RESULTS HER2 mRNA-positive CTCs were detected in 45 (21%) patients. Adjuvant chemotherapy could eliminate HER2 mRNA-positive CTCs in 16 (30.2%) prechemotherapy-positive patients. Moreover, HER2 mRNA-positive CTCs were detected in eight (5%) of 161 prechemotherapy-negative patients. The detection of HER2 mRNA-positive CTCs after chemotherapy was associated with reduced disease-free interval (DFI) (P = 0.006) but not with overall survival (P = 0.2); this effect was mainly observed in node-negative patients (P = 0.04) and to a lesser extent in node-positive (P = 0.06). Multivariate analysis revealed that the detection of HER2 mRNA-positive CTCs was an independent predictive factor for DFI (hazard ratio 3.238, P < 0.0005). CONCLUSIONS The detection of HER2 mRNA-positive CTCs after the completion of adjuvant chemotherapy may provide clinically useful information concerning the efficacy of treatment and the prognosis of patients with operable breast cancer.
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Affiliation(s)
- S Apostolaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
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30
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MacGuill MJ, Barrett C, Ravi N, MacDonald G, Reynolds JV. Isolated tumour cells in pathological node-negative lymph nodes adversely affect prognosis in cancer of the oesophagus or oesophagogastric junction. J Clin Pathol 2007; 60:1108-11. [PMID: 17220206 PMCID: PMC2014831 DOI: 10.1136/jcp.2006.044149] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To determine the prevalence of isolated tumour cells (ITC) in lymph nodes of patients with pathological node-negative (pN0) tumours and to assess their impact on disease-free and overall survival. METHODS Paraffin embedded lymph nodes from oesophagogastrectomy specimens were examined immunohistochemically using monoclonal anti-cytokeratin antibody (MNF118). Clinical and pathological features were summarised and overall and relapse-free survival were estimated. RESULTS Isolated tumour cells were detected in 12 of 146 patients (8%), and 24 of 1694 (1%) lymph nodes. With a median follow-up time of 28 months (range 0-160 months), both relapse-free and overall survival were significantly (p<0.05) associated with the presence of ITC in pN0 lymph nodes. There was no significant difference in the prevalence of ITC between patients who underwent multimodal therapy and those treated with surgery alone. CONCLUSIONS ITC in pN0 lymph nodes may be less frequent than previously considered, but their presence is associated with poorer outcomes compared with true node negative disease.
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Affiliation(s)
- Martin J MacGuill
- Department of Surgery, St James's Hospital and Trinity College, Dublin, Ireland
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31
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Gretschel S, Bembenek A, Schulze T, Kemmner W, Schlag PM. [Minimal residual tumor in gastrointestinal carcinoma. Relevance to prognosis and oncologic surgical consequences]. Chirurg 2006; 77:1104-17. [PMID: 17119886 DOI: 10.1007/s00104-006-1263-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Isolated tumor cells as a consequence of minimal residual disease are often not detectable by routine diagnostic procedures. However, before or after surgery, isolated tumor cells in lymph nodes, the peritoneal cavity, blood, or bone marrow can frequently be identified by immunohistochemical or molecular methods. Failure to reveal the presence of such cells results in under-staging of tumor patients and may constitute the source of unexpected tumor recurrence after radical surgery. These facts emphasize the importance of isolated tumor cells at least as a surrogate marker. The frequency of appearance of isolated tumor cells in different organ systems also depends on the type of primary tumor. Developments in modern detection methods have led to increasing sensitivity but at the expense of specificity. Isolated tumor cells demonstrate remarkable heterogeneity with respect to proliferative potential and tumorigenicity. This characteristic is also reflected by a striking variability in the expression of various genes conditioning the aforementioned biological behavior. Unfortunately there is also remarkable heterogeneity in methods used for sampling and processing patient material as well as for the enrichment and detection of isolated tumor cells. Despite the ongoing controversies concerning detection methods and biological significance of isolated tumor cells, several clinical trials providing data supporting the prognostic relevance of minimal residual disease should also be considered for gastrointestinal carcinoma. In future this finding should be integrated in the planning of trials in surgical oncology, and "minimal residual disease" should receive stronger attention as a stratification criterion in such clinical studies.
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Affiliation(s)
- S Gretschel
- Klinik für Chirurgie und Chirurgische Onkologie, Robert-Rössle-Klinik am Helios Klinikum Berlin, Universitätsmedizin Berlin, Charite Campus Buch, Lindenberger Weg 80, 13125 Berlin
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Lin WY, Song CY, Pan TM. Proteomic analysis of Caco-2 cells treated with monacolin K. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2006; 54:6192-200. [PMID: 16910707 DOI: 10.1021/jf061060c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Monascus species is an important traditional fermentation fungus used on food. Monacolin K (a secondary metabolite of Monascus, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase) in inhibition of mevalonate synthesis may result in reductions of isoprenoid prenylation in cells. Impairment of protein isoprenoid prenylation has been related to anticancer effect in cancer cells. As a functional food for Monascus, however, the molecular mechanisms responsible for the anti-proliferate effect of monacolin K in cancer cells are not clear. We used proteomic analysis by two-dimensional gel electrophoresis, matrix-assisted laser desorption ionization time-of-flight/time-of-flight mass spectrometry (MALDI-TOF/TOF MS), tandem mass spectrometry (MS/MS), and database interrogation to separate and identify the proteins of Caco-2 cells treated with monacolin K. The results showed that monacolin K inhibited the proliferation of Caco-2 cells in a dose-dependent manner. The identified proteins in proteomic analysis included anti-oxidation enzymes related to reactive oxygen species stress, cytoskeleton proteins, glycolytic enzymes, and enzymes involved in mediating protein interactions. Furthermore, glutathione S-transferase P 1 and cytoskeleton-8, -18, and -19 revealed a down-regulation in a dose-dependent manner in exposure of Caco-2 cells to monacolin K.
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Affiliation(s)
- Wun-Yuan Lin
- Department of Food Science, Nutrition and Nutraceutical Biotechnology, Shih Chien University, Taipei, Taiwan, Republic of China
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33
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Loo WTY, Fong JHM, Zhu L, Cheung MNB, Chow LWC. The value of bone marrow aspirates culture for the detection of bone marrow micrometastasis in breast cancer. Biomed Pharmacother 2006; 59 Suppl 2:S384-6. [PMID: 16507415 DOI: 10.1016/s0753-3322(05)80084-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Detection of micrometastasis is an important problem of clinical significance for a better understanding and control of tumor progression, which will improve patients' survival time. Tumor cells in bone marrow (BM) aspirates are indicative of the general disseminative metastasis in patients with early breast cancer and characterization of breast cancers by various tumor markers which are appropriate for the identification of high risk groups. MATERIALS AND METHODS Bone marrow aspirates were obtained from 44 breast cancer patients at the time of surgery. To identify micrometastases in bone marrow, an immunocytochemical assay for epithelial cytokeratin (CK) was performed at the second passage after selective culture. Cytokeratin-positive bone marrow disseminated cancer cells were observed in more than 90% of the patients. This high incidence needs further investigation with bigger sample size to confirm. However, these results indicate that this technique can be used as an early diagnostic technique of bone marrow micrometastases in the patient with breast cancer thereby promoting the development of therapeutic strategy. High incidences need further investigation with bigger samples to confirm.
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Affiliation(s)
- W T Y Loo
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, China
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34
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Willipinski-Stapelfeldt B, Riethdorf S, Assmann V, Woelfle U, Rau T, Sauter G, Heukeshoven J, Pantel K. Changes in cytoskeletal protein composition indicative of an epithelial-mesenchymal transition in human micrometastatic and primary breast carcinoma cells. Clin Cancer Res 2006; 11:8006-14. [PMID: 16299229 DOI: 10.1158/1078-0432.ccr-05-0632] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The bone marrow is a frequent and clinically important homing site for early disseminated breast cancer cells. Here, we aimed to profile the protein expression of these cells using unique cell line models and to evaluate the prognostic relevance of candidate gene expression for breast cancer patients. EXPERIMENTAL DESIGN To identify expression patterns characteristic for micrometastatic cells, three different cell lines (BC-K1, BC-P1, and BC-S1) established by SV40 immortalization of cancer cells isolated from the bone marrow of patients with breast cancer were compared with MCF-7 breast cancer and SV40 immortalized normal breast ductal cells (MTSV-1.7) using two-dimensional gel electrophoresis followed by MALDI-ToF analysis. The prognostic significance and clinicopathologic associations of selected differentially expressed proteins were evaluated using high-density breast cancer tissue microarrays. RESULTS In contrast to MCF-7 and MTSV1-7 reference cell lines, all micrometastatic cancer cell lines displayed loss of epithelial cytokeratins (CK8, CK18, and CK19) and ectopic expression of vimentin commonly present in mesenchymal cells. Immunohistochemical analysis of 2,517 samples of breast cancer further showed that loss of cytokeratin and ectopic vimentin expression were significantly associated with a higher tumor grade, high mitotic index, and negative estrogen/progesterone-receptor status. Although in univariate analyses significantly related to clinical outcome, none of the cytokeratins analyzed were independently associated with either overall or cancer-specific survival. CONCLUSIONS Micrometastatic cancer cells exhibit marked changes in the expression pattern of cytoskeletal proteins indicative of an epithelial-mesenchymal transition. This phenotypical change could already be detected in primary tumors and is associated with the aggressive behavior of breast cancer cells in vivo.
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35
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Pantel K, Woelfle U. Detection and molecular characterisation of disseminated tumour cells: Implications for anti-cancer therapy. Biochim Biophys Acta Rev Cancer 2005; 1756:53-64. [PMID: 16099109 DOI: 10.1016/j.bbcan.2005.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 06/27/2005] [Accepted: 07/15/2005] [Indexed: 12/22/2022]
Abstract
Haematogenous distant metastasis is the leading cause of cancer-related death in solid tumours. By applying sensitive immunocytochemical and molecular assays, disseminated tumour cells (DTC) in bone marrow (BM) can be detected in 20-40% of cancer patients without any clinical or even histopathological signs of metastasis, and the presence of these DTC at primary diagnosis predicts the subsequent occurrence of overt metastases in bone and other organs. The detection and characterisation of DTC in BM may lead to a better understanding of the biology initiating metastatic spread in cancer patients and will eventually contribute to the development of more effective strategies to eliminate DTC. In this review, we will therefore discuss the detection and characterisation of DTC in the light of new therapeutic strategies targeting tumour-associated molecules and signalling pathways.
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Affiliation(s)
- Klaus Pantel
- Institute of Tumour Biology, Centre of Experimental Medicine, University Medical Center Hamburg, Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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36
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Sutcliffe R, Maguire D, Murphy P, Portmann B, Rela M, O'Sullivan G, Mufti G, Heaton N. Detection and clinical significance of bone marrow micrometastases in patients undergoing liver transplantation for hepatocellular carcinoma. Transplantation 2005; 80:88-94. [PMID: 16003238 DOI: 10.1097/01.tp.0000164499.40952.c8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Existing methods of selecting patients with hepatocellular carcinoma (HCC) for liver transplantation rely on computed tomography and magnetic resonance imaging, which fail to detect vascular invasion or micrometastases. Vascular invasion cannot be assessed pretransplant because of the risks of tumor biopsy. Pretransplant detection of micrometastases in bone marrow is an alternative method that may identify patients at risk of recurrence and permit better organ allocation. The authors' aim was to develop an accurate method of detecting hepatocellular carcinoma micrometastases that may have a clinical role in pretransplant assessment. METHODS Iliac crest bone marrow was sampled from 18 patients with HCC (before liver transplantation) and 14 controls (cirrhosis, 9; hematologic disorders, 5). Mononuclear bone marrow fractions were evaluated for the presence of micrometastases by immunocytochemistry (ICC) using Hep Par-1 (HPICC) and Glypican-3 (GPICC), and by reverse-transcriptase (RT) polymerase chain reaction using two primer pairs targeting albumin (Alb1RT and Alb2RT) and one pair targeting alpha-fetoprotein (AFPRT). Each marker was compared in terms of (1) specificity and (2) positive and negative predictive values for tumor recurrence. RESULTS The specificity of each marker for detecting HCC micrometastases were as follows: HPICC, 93%; GPICC, 92%; Alb1RT, 33%; Alb2RT, 59%; and AFPRT, 0%. The positive (negative) predictive values for HPICC, GPICC, and Alb2RT for posttransplant tumor recurrence were 42% (100%), 40% (73%), and 0% (43%), respectively. HPICC-positive micrometastases were identified in all patients with postoperative tumor recurrence (n=5) and in 75% of patients with microscopic vascular invasion. CONCLUSIONS Detection of HCC micrometastases in bone marrow of potential liver transplant candidates is a potentially useful technique that may provide important prognostic information without the need for preoperative tumor biopsy. The authors' preliminary data indicate that HPICC is a promising immunocytochemical marker for HCC micrometastases, and larger studies are needed to confirm its clinical role.
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Affiliation(s)
- Robert Sutcliffe
- Liver Transplant Unit, King's College Hospital, London, United Kingdom
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37
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Illert B, Fein M, Otto C, Cording F, Stehle D, Thiede A, Timmermann W. Disseminated tumor cells in the blood of patients with gastric cancer are an independent predictive marker of poor prognosis. Scand J Gastroenterol 2005; 40:843-9. [PMID: 16109661 DOI: 10.1080/00365520510015557] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gastric cancer carries a poor prognosis even after curative resection (R0). Tumor progression in gastric cancer patients has been attributed to the persistence of disseminated tumor cells (DTC) in various body compartments as a sign of minimal residual disease, although the prognostic relevance of DTC is still unclear. In this study the prognostic relevance of DTC in the blood of gastric cancer patients was investigated. MATERIALS AND METHODS Venous blood samples of 70 cancer patients were taken intraoperatively before surgical manipulation and examined by reverse transcription-polymerase chain reaction (RT-PCR) for expression of cytokeratin 20 (CK20) as a marker for DTC. Tumor-related survival was analyzed using univariate and multivariate models assessing occurrence of DTC, residual tumor classification, and tumor stage. Median follow-up was 20 months (range 1-57 months). RESULTS Twenty-eight of the 70 patients (40%) were CK20 positive. The prevalence of DTC in patients following R0 resection (15/41, 37%) was similar to that in patients with residual tumor (13/29, 45%, NS). Furthermore, expression of CK20 was independent of TNM stage. Univariate analysis of R0-resected patients revealed CK20 to be a marker for significantly shorter tumor-related survival (p = 0.0363). In a multivariate analysis, CK20 was an independent prognostic marker. Detection of CK20 had greatest impact for early tumor stages (T1 and T2, N0; p < 0.0032). CONCLUSIONS Detection of DTC in venous blood of gastric cancer patients is an independent predictive marker of poor prognosis and thus could help to define patients for adjuvant therapy with this tumor entity.
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Yoshida K, Kashima K, Suenaga S, Nomi N, Shuto J, Suzuki M. Immunohistochemical detection of cervical lymph node micrometastases from T2N0 tongue cancer. Acta Otolaryngol 2005; 125:654-8. [PMID: 16076716 DOI: 10.1080/00016480410025252] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSIONS These results indicate that extensive, multiple cervical micrometastases occurred from an early stage in patients with T2N0 tongue cancer. The presence of micrometastases suggests the necessity of preventive neck dissection for Level I-IV nodes as a radical treatment. OBJECTIVE Cervical lymph node metastases occur with a relatively high frequency in patients with T2N0 squamous cell carcinoma of the tongue, and control of the metastases greatly influences the prognosis of patients. In this study, micrometastases in the cervical lymph nodes were investigated to clarify the necessity and required extent of preventive neck dissection. MATERIAL AND METHODS We investigated micrometastases in 24 subjects who had previously been diagnosed with T2N0 tongue cancer. We performed immunostaining with anti-cytokeratin antibody cocktail AE1/AE3 of sections of 401 paraffin-embedded lymph nodes obtained from these patients. RESULTS Micrometastases were observed in 14 patients (58%) and were most abundant in Level II nodes (n=11; 46%). Micrometastases were observed in the Level IV nodes of 3 patients (13%), and upstaging to pN2b occurred in 7 patients (29%).
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Affiliation(s)
- Kazuhide Yoshida
- Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan
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Coello MC, Luketich JD, Litle VR, Godfrey TE. Prognostic significance of micrometastasis in non-small-cell lung cancer. Clin Lung Cancer 2004; 5:214-25. [PMID: 14967073 DOI: 10.3816/clc.2004.n.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Accurate staging of non-small-cell lung cancer (NSCLC) determines prognosis and facilitates decisions regarding treatment options. Unfortunately, even after an apparently complete resection in patients with stage I disease, the recurrence rates range from 25% to 50%, and overall survival is not encouraging. One possible reason for this may be that those patients with a poor outcome actually have more extensive disease, with occult locoregional and/or distant metastasis than originally identified by routine pathologic staging techniques. There is now a sizable body of literature on the detection and possible prognostic role of occult disease in lung cancer. The majority of these studies are based on immunohistochemical analysis of lymph nodes and/or bone marrow, but a handful of studies use molecular approaches. The purpose of this review is to summarize and critique the current literature on occult tumor cell spread to lymph nodes and bone marrow in patients with NSCLC. Based on this literature, we believe that the prognostic significance of bone marrow micrometastasis remains unclear. However, the majority of studies indicate that occult lymph node disease is associated with a poor outcome. Thus, our ability to detect individual tumor cells could result in more accurate staging of NSCLC in patients and would potentially lead to the development of novel therapies, as well as influence decisions regarding the use of appropriate multimodality treatment strategies, the choice of surgical technique, and extent of dissection. As data accumulate, the presence or absence of occult nodal involvement should probably be considered at the next revision of the staging system for NSCLC.
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Affiliation(s)
- Michael C Coello
- Division of Thoracic Surgery, University of Pittsburgh, PA 15213, USA
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40
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Ryan P, McCarthy S, Kelly J, Collins JK, Dunne C, Grogan L, Breathnach O, Shanahan F, Carey PD, Walsh TN, O'Sullivan GC. Prevalence of bone marrow micrometastases in esophagogastric cancer patients with and without neoadjuvant chemoradiotherapy. J Surg Res 2004; 117:121-6. [PMID: 15013722 DOI: 10.1016/j.jss.2003.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2003] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bone marrow micrometastases are present in a high proportion of patients undergoing curative resection for esophagogastric cancer. The incorporation of preoperative systemic therapies into these patients' treatment is widely practiced. This study investigates the effect of neoadjuvant chemoradiotherapy (CRT) on the incidence of micrometastases and the viability of detected tumor cells. MATERIALS AND METHODS Rib bone marrow was obtained from patients (n = 106) in three centers, who were selected for potentially curative resection. Patients received neoadjuvant CRT plus surgery (n = 55), or surgery alone (n = 51). To detect micrometastases, mononuclear cells were isolated from fresh marrow and immediately stained immunohistochemically with an anti-cytokeratin-18 antibody using the APAAP technique. Tumor cell viability was assessed by immunohistochemical staining of marrow cell cultures for cytokeratin-positive cells. RESULTS Micrometastases were detected in fresh marrow in 42% (23/55) of patients who received neoadjuvant CRT plus surgery, and in 67% (34/51) of patients treated with surgery alone. Viable tumor cells were demonstrated in 10 of 18 marrow cultures from CRT plus surgery cases. In this patient subset, combination of results of staining fresh and cultured marrow significantly increased micromet detection to 78%. CONCLUSIONS A significant proportion of patients with esophagogastric cancer have disseminated viable tumor cells at time of surgery, irrespective of pre-operative treatment. The use of marrow culture in parallel with fresh marrow staining may increase the detection of micrometastases. The persistence of tumor cells resistant to systemic therapy may explain why these regimens fail in a majority of patients.
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Affiliation(s)
- Paul Ryan
- Cork Cancer Research Centre, National University of Ireland, Cork, Dublin, Ireland.
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41
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Gangnus R, Langer S, Breit E, Pantel K, Speicher MR. Genomic Profiling of Viable and Proliferative Micrometastatic Cells from Early-Stage Breast Cancer Patients. Clin Cancer Res 2004; 10:3457-64. [PMID: 15161702 DOI: 10.1158/1078-0432.ccr-03-0818] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Metastases in distant organs are the major cause of death for cancer patients, and bone marrow is a prominent homing organ for early disseminated cancer cells. However, it remains still unclear which of these cells evolve into overt metastases. We therefore established a new approach based on the analysis of viable and proliferating cancer cells by single-cell comparative genomic hybridization. EXPERIMENTAL DESIGN The bone marrow of early-stage breast tumor patients (pN(0)M(0)) was screened for tumor cells by immunostaining. By applying special short-term culturing, we selected for viable and proliferative tumor cells. The short-term culturing allowed us to evaluate the proliferative potential of micrometastatic cells, which we had previously shown to represent an independent prognostic marker. We assessed genomic changes in single disseminated cancer cells by single-cell comparative genomic hybridization. RESULTS We found that these viable disseminated cancer cells already had a plethora of copy number changes in their genome. All of these cells showed chromosomal copy number changes with a substantial intercellular heterogeneity and differences to the matching primary tumors. CONCLUSIONS The established experimental strategy might pave the way for the identification of metastatic stem cells in cancer patients. Our preliminary results support the new concept that early disseminated cancer cells evolve independently from their primary tumor.
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Affiliation(s)
- Rainer Gangnus
- Institut für Humangenetik, Technische Universität München, München, Germany
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42
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Krüger WH, Lange A, Badbaran A, Gutensohn K, Kröger N, Zander AR. Detection of disseminated epithelial cancer cells by liquid culture--factors interfering with the standardization of assays. Cytotherapy 2004; 5:252-8. [PMID: 12850794 DOI: 10.1080/14653240310001514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Immunocytochemistry is the standard method for detection of disseminated breast-cancer cells. Tumor-cell enrichment by cell culture has been used by several investigators, however assays published have not been well-standardized. METHODS Breast-cancer cells from two lines were diluted in hemopoietic cells of varying origins and cultured in different media and different flasks. Factors influencing successful tumor-cell amplification by liquid culture were identified by investigation of 277 cultures. Parallel clinical samples, consisting of BM aspirations, leukapheresis samples and peripheral blood samples obtained from women with breast cancer, were investigated in 113 cultures. Cancer-cell detection by cell culture could be compared to immunocytochemistry in 101 cases. RESULTS The frequency of tumor-cell detection was not improved by liquid culture, but a significant correlation between conventional tumor-cell detection and detection after liquid culture was found. Factors influencing tumor-cell amplification in the dilution assay could not be transferred to the investigation of clinical samples. It was concluded that culture-enrichment of disseminated cancer cells was very complex, and could be influenced by a variety of factors-even when a model system was used. DISCUSSION It should be recognized that culture-enriched cancer cells probably represent a highly selected population of disseminated cancer cells, despite the significant correlation between tumor cells detected by conventional methods and following conventional methods after liquid culture. There is currently no evidence to suggest that cancer-cell amplification by cell culture could become a standardized technique for the detection of disseminated epithelial tumor cells.
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Affiliation(s)
- W H Krüger
- Bone Marrow Transplantation, Centre University-Hospital, Hamburg-Eppendorf, Germany
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43
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Braun S, Vogl FD, Janni W, Marth C, Schlimok G, Pantel K. Evaluation of bone marrow in breast cancer patients: prediction of clinical outcome and response to therapy. Breast 2003; 12:397-404. [PMID: 14659112 DOI: 10.1016/s0960-9776(03)00143-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Blood-borne distant metastasis is the leading cause of cancer-related death in breast cancer. The onset of this fundamental process can now be assessed in cancer patients by using ultrasensitive immunocytochemical and molecular assays able to detect even single metastatic cells. To date, clinical studies with large study populations, validated immunoassays, and adequate follow-up time provide evidence for the independent prognostic value of the presence of disseminated tumor cells in the bone marrow. At present, bone marrow evaluation may therefore be considered a diagnostic tool for improved risk assessment with regard to distant relapse and death, especially among potentially curable breast cancer patients. Except for promising pilot studies, no data are available to support the immediate use of bone marrow evaluation for treatment monitoring in order to enable the prediction of response to adjuvant therapy.
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Affiliation(s)
- Stephan Braun
- Department of Ob/Gyn, University Hospital, Innsbruck, Austria.
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44
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Pierga JY, Bonneton C, Magdelénat H, Vincent-Salomon A, Nos C, Pouillart P, Thiery JP. Clinical significance of proliferative potential of occult metastatic cells in bone marrow of patients with breast cancer. Br J Cancer 2003; 89:539-45. [PMID: 12888827 PMCID: PMC2394390 DOI: 10.1038/sj.bjc.6601121] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There is increasing statistical evidence that the presence of tumour cells in bone marrow detected by immunocytochemistry represents an important prognostic indicator in breast cancer, but their individual capacity to become clinical metastases is unknown. The aim of this study was to assess the proliferative capacity of these occult metastatic cells in the bone marrow of patients with various stages of breast cancer. We obtained bone marrow aspirates from 60 patients with breast cancer before treatment with chemotherapy: 17 stage II, 12 stage III and 31 stage IV. After bone marrow culture for 6-34 days (median: 17 days) under specific cell culture conditions, viable epithelial cells were detected by cytokeratin staining in 40 patients (66%). Expansion of tumour cells was poorly correlated with tumour cell detection on primary screening (P=0.06). There was a nonsignificant correlation between the number and the presence of expanded tumour cells and the UICC stage of the patients. On primary screening, tumour cell detection was positive in 56% of patients and was correlated with clinical UICC stage (P=0.01). However, with a median follow-up of 23 months, expansion of tumour cells from bone marrow was associated with decreased patient survival (P=0.04), whereas the survival difference according to detection of CK-positive cells on primary screening was not statistically significant. In conclusion, viable tumour cells can be detected in the bone marrow of breast cancer patients. Their proliferative potential could be predictive of outcome and deserves further investigation.
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Affiliation(s)
- J-Y Pierga
- Medical Oncology Department, Institut Curie, 75248 Paris Cedex 05, France.
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45
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Xenidis N, Vlachonikolis I, Mavroudis D, Perraki M, Stathopoulou A, Malamos N, Kouroussis C, Kakolyris S, Apostolaki S, Vardakis N, Lianidou E, Georgoulias V. Peripheral blood circulating cytokeratin-19 mRNA-positive cells after the completion of adjuvant chemotherapy in patients with operable breast cancer. Ann Oncol 2003; 14:849-55. [PMID: 12796021 DOI: 10.1093/annonc/mdg259] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic significance of the molecular detection of cytokeratin 19 (CK-19) mRNA-positive cells in the peripheral blood of women with operable breast cancer after the completion of adjuvant chemotherapy. PATIENTS AND METHODS Blood from 161 patients with stage I and II breast cancer, obtained after the completion of adjuvant chemotherapy, was tested by nested RT-PCR for CK-19 mRNA detection. Using univariate and multivariate analyses possible interactions with other prognostic factors and association of CK-19 mRNA detection with risk of relapse, disease-free interval (DFI) and overall survival were investigated. RESULTS After completion of adjuvant chemotherapy, 27.3% of patients had peripheral blood CK-19 mRNA-positive cells; there was no association of this finding with any other prognostic factors or the type of chemotherapy regimen used. For patients with less than four involved axillary lymph nodes the risk of relapse was 3.81 [95% confidence interval (CI) 1.06-13.71] times higher, and the DFI was significantly reduced (P = 0.028) if CK-19 mRNA-positive cells were detectable in the blood after the completion of adjuvant chemotherapy. In contrast, for patients with four or more involved lymph nodes, the presence of CK-19 mRNA-positive cells after adjuvant chemotherapy did not significantly affect the risk of relapse or DFI. Furthermore, the risk of relapse was higher (hazards ratio 3.70; 95% CI 1.09-13.89) and the DFI was reduced (P = 0.022) for patients with detectable CK-19 mRNA-positive cells following adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) as compared with epirubicin, cyclophosphamide and 5-fluorouracil (FEC) or sequential taxotere-epirubicin and cyclophosphamide (T/EC) chemotherapy. CONCLUSIONS The detection of CK-19 mRNA-positive cells in the peripheral blood after adjuvant chemotherapy may be of clinical relevance for patients with early breast cancer and less than four involved axillary lymph nodes.
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Affiliation(s)
- N Xenidis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
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46
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Iorgulescu DG, Kiroff GK. Minimal residual marrow disease: Detection and significance of isolated tumour cells in bone marrow. ANZ J Surg 2003. [DOI: 10.1046/j.1440-1622.2001.02110.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Kraus J, Pantel K, Pinkel D, Albertson DG, Speicher MR. High-resolution genomic profiling of occult micrometastatic tumor cells. Genes Chromosomes Cancer 2003; 36:159-66. [PMID: 12508244 DOI: 10.1002/gcc.10160] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Metastasis is responsible for most deaths from cancer. Currently, little is known about the early genetic events in the metastatic evolution. Here we describe the application of a newly developed strategy for an in-depth characterization of genomic changes in micrometastatic cells. Unique tumor cell lines were established from bone marrow of patients with cancer of the prostate and analyzed by multiplex-FISH (M-FISH) and array CGH. M-FISH revealed that the occult disseminated cells were characterized by very complex numerical and structural aberrations. Many of these aberrations resulted in chromosomal gains and losses, such as losses of 8p, 13q, and 18q and gains of 8q, 9q, 20, and the X chromosome, which are typically observed in prostate cancer. Array CGH allowed an unprecedented high-resolution assessment of copy number changes, pinpointing commonly gained or lost regions, which should narrow down the identification of regions critically involved in metastasis. Thus, occult micrometastatic cells are now amenable to detailed analyses of their genome. Markers for prognosis and treatment decisions can now be established.
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Affiliation(s)
- Jürgen Kraus
- Institut für Humangenetik, Technische Universität München, Munich, Germany
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48
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Oki E, Maehara Y, Tokunaga E, Shibahara K, Hasuda S, Kakeji Y, Sugimachi K. Detection of disseminated cancer cells in bone marrow of gastric cancer using real time quantitative reverse transcriptase polymerase chain reaction. Cancer Lett 2002; 188:191-8. [PMID: 12406564 DOI: 10.1016/s0304-3835(02)00057-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bone marrow is a prognostically relevant indicator organ for micrometastasis. In the present study, real time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect disseminated gastric cancer cells in bone marrow. We compared CEA, CK18 and CK20 expression using four gastric cancer cell lines and three normal tissue cell lines in order to select the most appropriate marker for detection of disseminated gastric cancer cell in bone marrow. CK20 proved to be the most promising marker since the expression level of normal cell lines was extremely low and about 50--100-fold differences were found between gastric carcinoma cell lines and normal tissue cell lines. We also screened bone-marrow RNA of 47 patients with gastric cancers, using this system. Among the three markers we tested, with only about CK20 could we find that 27 of 47 patients were positive. Though long-term clinical follow up studies are needed to evaluate the clinical significance of this method, real time quantitative RT-PCR is sensitive and quantitative for detection of micrometastasis in bone marrow.
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Affiliation(s)
- Eiji Oki
- Cancer Center, Kyushu University Hospital: Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Solakoglu O, Maierhofer C, Lahr G, Breit E, Scheunemann P, Heumos I, Pichlmeier U, Schlimok G, Oberneder R, Kollermann MW, Kollermann J, Speicher MR, Pantel K. Heterogeneous proliferative potential of occult metastatic cells in bone marrow of patients with solid epithelial tumors. Proc Natl Acad Sci U S A 2002; 99:2246-51. [PMID: 11854519 PMCID: PMC122350 DOI: 10.1073/pnas.042372199] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bone marrow is a major homing site for circulating epithelial tumor cells. The present study was aimed to assess the proliferative capacity of occult metastatic cells in bone marrow of patients with operable solid tumors especially with regard to their clinical outcome. We obtained bone marrow aspirates from 153 patients with carcinomas of the prostate (n = 46), breast (n = 45), colon (n = 33), and kidney (n = 29). Most of the patients (87%) had primary disease with no clinical signs of overt metastases [tumor-node-metastasis (TNM)-stage UICC (Union Internationale Contre le Cancer) I-III]. After bone marrow was cultured for 21-102 days under special cell culture conditions, viable epithelial cells were detected by cytokeratin staining in 124 patients (81%). The cultured epithelial cells harbored Ki-ras2 mutations and numerical chromosomal aberrations. The highest median number of expanded tumor cells was observed in prostate cancer (2,619 per flask). There was a significant positive correlation between the number of expanded tumor cells and the UICC-stage of the patients (P = 0.03) or the presence of overt metastases (P = 0.04). Moreover, a strong expansion of tumor cells was correlated to an increased rate of cancer-related deaths (P = 0.007) and a reduced survival of the patients (P = 0.006). In conclusion, the majority of cancer patients have viable tumor cells in their bone marrow at primary tumor diagnosis, and the proliferative potential of these cells determines the clinical outcome.
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Affiliation(s)
- Oender Solakoglu
- Molekulare Onkologie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
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50
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Abstract
Early metastasis is a well-known feature of poor prognosis in potentially resectable non-small cell lung cancer (NSCLC). However, a significant number of lymph node-negative patients die early of metastatic disease. Therefore, it has to be assumed that in some patients an early tumor cell dissemination has occurred which is clearly underestimated by current staging procedures. Recently, it has been shown, that an early dissemination of individual carcinoma cells to regional lymph nodes or bone marrow can be detected by using sensitive immunocytochemical techniques with monoclonal antibodies against epithelium-specific proteins. The incidence of immunohistochemically positive patients varies between 30 and 70% depending on the type of primary tumor, the immunohistochemical staining procedure used and especially on the primary monoclonal antibody. The detection of disseminated tumor cells in lymph nodes or bone marrow by immunocytochemistry is associated with a poorer prognosis in lung cancer. In conclusion, the immunohistochemical detection of disseminated tumor cells in lymph nodes can help to obtain a more exact identification of patients with an unfavorable prognosis. Whether the identified patients will gain from an adjuvant therapy, has to be evaluated in further studies.
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Affiliation(s)
- B Passlick
- Department of Surgery, Division of Thoracic Surgery, University of Munich, Klinikum Innenstadt, Nussbaumstrasse 20, 80336 Munich, Germany.
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