Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 14, 2007; 13(2): 257-263
Published online Jan 14, 2007. doi: 10.3748/wjg.v13.i2.257
Detection of disseminated pancreatic cells by amplification of cytokeratin-19 with quantitative RT-PCR in blood, bone marrow and peritoneal lavage of pancreatic carcinoma patients
Katrin Hoffmann, Christiane Kerner, Wolfgang Wilfert, Marc Mueller, Joachim Thiery, Johann Hauss, Helmut Witzigmann
Katrin Hoffmann, Christiane Kerner, Johann Hauss, Helmut Witzigmann, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig, Germany
Wolfgang Wilfert, Marc Mueller, Joachim Thiery, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Katrin Hoffmann, Department of General Surgery, Ruprecht Karls University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany. katrin.hoffmann@med.uni-heidelberg.de
Telephone: +49-6221-566110 Fax: +49-6221-564215
Received: September 5, 2006
Revised: September 25, 2006
Accepted: November 28, 2006
Published online: January 14, 2007
Abstract

AIM: To evaluate the diagnostic potential of cytokeratin-19 (CK-19) mRNA for the detection of disseminated tumor cells in blood, bone marrow and peritoneal lavage in patients with ductal adenocarcinoma of the pancreas.

METHODS: Sixty-eight patients with pancreatic cancer (n = 37), chronic pancreatitis (n = 16), and non-pancreatic benign surgical diseases (n = 15, control group) were included in the study. Venous blood was taken preoperatively, intraoperatively and at postoperative d 1 and 10. Preoperative bone marrow aspirates and peritoneal lavage taken before mobilization of the tumor were analyzed. All samples were evaluated for disseminated tumor cells by CK-19-specific nested-PCR and quantitative fluorogenic RT-PCR.

RESULTS: CK-19 mRNA expression was increased in 24 (64%) blood samples and 11 (30%) of the peritoneal lavage samples in the patients with pancreatic cancer. In 15 (40%) of the patients with pancreatic cancer, disseminated tumor cells were detected in venous blood and bone marrow and/or peritoneal lavage. In the peritoneal lavage, the detection rates were correlated with the tumor size and the tumor differentiation. CK-19 levels were increased in pT3/T4 and moderately/poorly differentiated tumors (G2/G3). Pancreatic cancer patients with at least one CK-19 mRNA-positive sample showed a trend towards shorter survival. Pancreatic cancer patients showed significantly increased detection rates of disseminated tumor cells in blood and peritoneal lavage compared to the controls and the patients with chronic pancreatitis.

CONCLUSION: Disseminated tumor cells can be detected in patients with pancreatic ductal adenocar-cinoma by CK-19 fluorogenic RT-PCR. In peritoneal lavage, detection rate is correlated with tumor stage and differentiation. In the clinical use, CK-19 is suitable for the distinction between malignant and benign pancreatic disease in combination with other tumor-specific markers.

Keywords: Tumor cell dissemination, Pancreatic cancer, Cytokeratin-19