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Cytokeratin 20 by reverse transcriptase-polymerase chain reaction as a marker of tumor cells in peripheral venous and mesenteric blood of colorectal cancer patients

Purpose: To determine the usefulness of reverse transcriptase-polymerase chain reaction (RT-PCR) recognition of cytokeratin 20-encoding mRNA in assessing the extent of preoperative and intraoperative hematogenic tumor cell dissemination in patients with colorectal cancer undergoing primary tumor resection. Methods: Circulating tumor cells (CTC) were determined using conventional RT-PCR in preoperative peripheral venous blood of 65, intraoperative peripheral venous blood of 45, and mesenteric venous blood of 36 patients with colorectal cancer, and in peripheral venous blood of 21 healthy volunteers. Results: Positive findings were obtained in preoperative blood of 17% of AJCC stage 0-III vs. 56% stage IV pts (p=0.007), in mesenteric blood of 18% stage 0-III vs. 89% stage IV pts (p<0.001), and in none of the healthy volunteers. Among patients with liver metastases, positive results were found in 37.5% peripheral blood and in 100% mesenteric blood samples (p=0.063). 17% patients with negative preoperative findings became intraoperatively positive (p=0.031). Conclusion: Positive CTC findings in preoperative peripheral venous blood correlate to the clinical stage of the disease in colorectal cancer patients. CTC determination in mesenteric venous blood seems to be more indicative for liver metastases than their detection in preoperative peripheral venous blood. Surgical manipulation facilitates the dissemination of tumor cells by circulation.

circulating tumor cells, RT-PCR, cytokeratin-20, colorectal cancer

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