Abstract
Early detection of disseminated tumor cells in the peripheral blood of patients with early stage gastric cancer could help to improve the outcome after tumor resection. The aim of this study is to evaluate the prognostic significance of tumor-related mRNA for the detection of circulating tumor cells in gastric cancer patients by a reverse-transcriptase polymerase chain reaction (RT-PCR) method. We simultaneously analyzed human telomerase reverse transcriptase (hTERT), cytokeratin-19 (CK-19), cytokeratin-20 (CK-20) and carcinoembryonic antigen (CEA) mRNA (messenger RNA) expression in the peripheral blood of 42 gastric cancer patients and 30 healthy individuals. Additionally, analyses were carried out for the correlation of these four molecular markers with patients’ clinicopathologic features, as well as the occurrence of postoperative recurrence/metastasis. Among 42 gastric cancer patients, the prevalence of mRNA for hTERT, CK-19, CK-20, and CEA was 61.9% (26/42), 69% (29/42), 61.9% (26/42), and 78.6% (33/42), respectively. All 30 healthy individuals were negative for hTERT and CEA mRNA, while two were positive for either CK-19 mRNA or CK-20 mRNA. Positive CEA mRNA was significantly correlated with tumor size (p = 0.008), vessel invasion (p = 0.001), depth of tumor invasion (p = 0.007), lymph node metastasis (p < 0.001), and TNM stage (p < 0.001). In addition, the multivariate logistic regression demonstrated that CEA mRNA expression was an independent and significant predictor for postoperative recurrence/metastasis (p = 0.032). Our findings suggest that CEA mRNA may be a more reliable marker than hTERT, CK-19 and CK-20 for the detection of circulating cancer cells in gastric cancer patients' peripheral blood. Patients with positive CEA mRNA expression in peripheral blood have a significantly higher risk of postoperative recurrence/metastasis.
Highlights
Gastric cancer remains one of the most prevalent malignant tumors in Taiwan and throughout the world [1]
We found that carcinoembryonic antigen (CEA) mRNA expression was the most significant indicator for clinicopathologic characteristics and that it was closely correlated with tumor size (p = 0.008), vessel invasion (p = 0.001), depth of tumor invasion (p = 0.007), lymph node metastasis (p < 0.001), and TNM stage (p < 0.001)
No statistical significance was observed in the correlation between human telomerase reverse transcriptase (hTERT), CK19, and CK-20 mRNA expression and clinicopathologic characteristics of gastric cancer patients (ALL p > 0.05)
Summary
Gastric cancer remains one of the most prevalent malignant tumors in Taiwan and throughout the world [1]. Recent advances in the treatment of gastric cancer have provided improvement in clinical outcome of patients [2,3,4,5], the prognosis of patients with ad-. C.H. Wu et al / Molecular detection of disseminated gastric cancer cells vanced stages of this disease is unfavorable due to the high incidence of metastases and recurrence. Since early detection is an important factor contributing to reduction of cancer mortality, the development of a sensitive, specific and convenient diagnostic method for detecting gastric cancer at a very early stage is an issue of utmost importance. With the development of techniques in molecular biology, circulating tumor cells are detectable by using polymerase chain reaction (PCR) or reverse transcriptase-polymerase chain reaction (RT-PCR)
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