Bone marrow micrometastases predict early post-operative recurrence following surgical resection of oesophageal and gastric carcinoma

Aim: Tumour cells in the bone marrow of patients with gastrointestinal cancer may detect patients at higher risk of disease recurrence and death following potentially curative surgery. Methods: Immunocytochemistry using the monoclonal antibody Ber-EP4, which detects tumour cells from squamous and adenocarcinomas was used. In preliminary spiking experiments to define sensitivity, tumour cells were detected in blood at 103/ml. Bone marrow samples from 74 patients with oesophago-gastric cancer and from 14 control patients was examined. Results: 27 (36.5%) patients with cancer and one control patient had stained cells present in their bone marrow at the time of resection. During the follow up period (mean 14 months), relapse and disease-specific death were commoner in patients whose marrow contained tumour cells. Multivariate analysis confirmed bone marrow micrometastasis as an independent prognostic variable for both recurrence and survival. Conclusions: Bone marrow immunocytochemistry using Ber-EP4 may identify those patients at highest risk of early relapse following RO resection of oesophageal or gastric cancer.