The Expression Of CK19 In Peripheral Blood And Lymph Nodes Of Patients With Gastric Carcinoma

Objective: l.To evaluate the incidence of circulating cancer cells in gastric cancer patients and its relation with clinicopathological features. 2.To investigate the prognostic significance of gastric cancer micrometastasis in regional lymph nodes.Material and method: l.Cytokeratin19 mRNA expression was studied by reverse transcription-polymerase chain reaction (RT-PCR) in peripheral blood samples from 57 patients with gastric cancer (Of the 57 patients, 39 were treated by operation, the other 18 by systemic chemotherapy) before and after treatment (operation or chemotherapy). Peripheral blood samples from 20 healthy volunteers served as controls. 2.Thirty one patients with pathologic Ti.3N0M0 gastric carcinoma who underwent gastric resection between 1995 and 1997 were studied. The sections of the "negative" lymph nodes diagnosed by H&E staining were stained immunohistochemically by anti-CK19monoclonal antibody. Associations between clinicopathological factors and LN micrometastasis as well as micrometastasis and survival were sought.Results: 1. The CK19 mRNA was detected in 22.8% of gastric cancer patients (13/57) and 0% of the controls (0/20). Of the 13 positive patients, 5 patients were in stage III, 8 in stage IV. The expression of CK19 mRNA was related to the total TNM-stage and the invasive depth of tumor (p<0.05). It has no significant relation with LN involvement and tumor differentiation. In operative group, the incidence of Cytokeratin19 positive rose from 15.4% (preoperation) to 23.1% (postoperation). In chemotherapeutic group, two positive turned to negative after chemotherapy. The survival of the CK19 positive nonoperative patients was significantly shorter than the negative patients (p<0.05). 2.Micrometastasis was found in 32.3% of the patients. The occurrence was related with the depth of tumor invasion. The 5-year-survival of the patients with LN micrometastasis was lower than the patients without micrometastasis.Conclusions:CK19 is a useful tumor-marker to detectmicrometastasis in circulation and lymph nodes. It is also of value to predict prognosis, monitor therapeutic effects and offer suggestions for rationale treatment.