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Detection of cancer cells in peripheral and mesenteric blood of colorectal cancer patients using cytokeratin 20 as a marker

Detection of circulating cancer cells by reverse transcription- polymerase chain reaction (RT-PCR) has been studied as potential prognostic marker in patients with colorectal cancer but so far with conflicting results regarding specificity and prognostic value. In this study, cytokeratin 20 (CK20) was investigated as a marker for detection of circulating colorectal cancer cells by RT-PCR. The aim of the study was to investigate in patients with colorectal cancer (i.) if there is an association between the presence of circulating cancer cells and stage of the disease and (ii.) if there is a difference in circulating cancer cells detection between peripheral and mesenteric venous blood. Peripheral venous blood samples were obtained from 65 colorectal cancer patients before primary tumor dissection. From 36 of these patients also mesenteric blood samples were obtained intraoperatively. Blood samples from 21 healthy volunteers were analyzed as controls. Blood samples were analyzed by RT-PCR for the expression of CK20. All samples from healthy volunteers were negative for CK20. Preoperative peripheral blood samples were positive for CK20 in 14 (21.5%) out of 65 patients and mesenteric blood samples were positive in 10 (27.7%) out of 36 patients. A statistically significant trend of increase in the proportion of patients with positive values of CK20 with increasing stage of disease has been shown both in peripheral blood (p=0.008) and in mesenteric blood samples (p=0.0001) (Chi-square test for trend). No significant differences in proportion of CK20 positive results were found between preoperatively drawn peripheral blood and mesenteric blood. Among 8 patients with liver metastases, positive results were found in 3 (37.5%) peripheral blood samples and in all 8 (100%) mesenteric blood samples. An increase in the proportion of patients with positive value of CK20 with increasing stage of the disease both in peripheral and mesenteric blood shown in this study indicates potential prognostic value of CK20-specific circulating cancer cells detection in patients with colorectal cancer. Circulating colorectal cancer cells detection in mesenteric blood seems to be more indicative for liver metastases than their detection in preoperative peripheral blood.

colorectal cancer; reverse transcription-polymerase chain reaction; cytokeratin 20; circulating tumor cells

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