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[Clinical significance of detecting circulating cancer cells in patients with solid malignancies].

There have been several studies attempting to detect the existence of cancer cells in the peripheral blood of patients with solid malignancies. The use of RT-PCR assays for cytokeratin (CK), carcinoembryonic antigen (CEA), alpha-fetoproteins (AFP), prostate specific antigen (PSA) and prostate specific membrane antigen (PMSA) is likely to be practicable in the detection of circulating tumor cells from epithelial-derived malignancies. The positive rates varied widely among the studies attempting to detect circulating cancer cells in peripheral blood, even when the same targets were used, which may be explained by the sensitivity of the RT-PCR assays and the target genes used. Both false negative results and false positive results can be obtained with the RT-PCR assay system. Furthermore, cancer cells may be released from the primary cancer into the circulation intermittently rather than constantly, and the results may vary among the samples obtained at different time points. In this report, we review our recent studies and related studies by other researchers to show the advances and the problems in detecting circulating cancer cells in patients with solid malignancies. The clinical significance of detecting circulating cancer cells in peripheral blood remains to be determined.

Biomarkers, Tumor↗

Carcinoma cell-specific Mig-7: a new potential marker for circulating and migrating cancer cells.

Identification of genes that are expressed in a cancer cell-specific manner can provide markers for detection, diagnosis, and disease progression. We have previously reported that receptor tyrosine kinase ligands in concert with ligation of alphavbeta5 integrin induce expression of Mig-7 restricted to carcinoma cells. Because of this highly specific expression, we hypothesized that Mig-7 could be used as a marker of occult tumor cells. The objective of this study was to begin to test this hypothesis by generating Mig-7 specific antisera and RT-PCR methods for detection of Mig-7 expression in tissues and blood from cancer patients as compared to those from normal subjects. By immunohistochemistry and by RT-PCR, we detected Mig-7 mRNA in lymph nodes from 7 out of 9 (77.8%) endometrial carcinoma xenograft mice but not from any of the 5 negative control animals. Mig-7 expression was more specific than Met expression, the RTK that binds Scatter factor and is used as a marker of poor progression, in endometrial carcinoma as compared to normal endometrial tissue samples. In 87.3% of tumors from various tissues including breast, lung, colon and ovary, we detected Mig-7 expression. Blood samples from untreated metastatic cancer patients also displayed Mig-7 mRNA in contrast to a lack of expression in chemotherapy treated or normal individuals. In conclusion, we report the first immunohistochemical and RT-PCR assays for Mig-7 and discuss its highly specific localization to cancer cells in contrast to an absence in normal cells. Our preliminary data indicate that Mig-7 may be a potential early marker of migrating and circulating carcinoma cells.

Animals↗

Growth and metastasis of Lewis lung carcinoma in the footpad of mice.

When Lewis lung carcinoma cells were transplanted into the footpad of mice, exponential growth of tumour was seen from the 4th day. Intravasation of tumour cells was first seen at this time, then increased steadily up to the 10th day. Tumour cells entered the circulation by destructive degeneration of the vascular endothelium and also by transcellular passage, mainly through capillaries, venules and thin-walled tumour vascular channels. Multiple sites of entry of tumour cells into the circulation were frequently found. The rate of intravasation of tumour cells into the circulation was the same at the proximal, middle and distal portions of the tumour.

Animals↗

Sensitive detection of circulating breast cancer cells by reverse-transcriptase polymerase chain reaction of maspin gene.

BACKGROUND: Maspin, a recently identified protein related to the family of serpins, is believed to play a role in human breast cancer. In an effort to improve the present methods of detection, we have developed a reverse-transcriptase polymerase chain reaction (RT-PCR) assay for maspin transcript to identify small numbers of mammary carcinoma cells in the peripheral blood and bone marrow of patients with breast cancer. PATIENTS AND METHODS: Five non-neoplastic mammary tissue samples, 13 breast cancer specimens as well as 17 peripheral blood and 4 bone marrow samples from normal subjects were screened for the presence of maspin mRNA by RT-PCR. The same assay was applied to peripheral blood or bone marrow samples obtained from 29 patients with stages I to IV breast cancer. RESULTS: By RT-PCR it was possible to amplify maspin mRNA in all of the primary and metastatic breast cancer specimens, but in none of the normal hemopoietic samples from healthy donors. Thus, detection of maspin transcript in the peripheral blood or marrow of a patient known to have breast cancer is indicative of the presence of mammary carcinoma cells. In reconstitution experiments, maspin RT-PCR reliably detected 10 mammary carcinoma cells in 1 million normal peripheral-blood mononuclear cells (PBMCs). None of the 9 patients with stages I, II, or III breast cancer had maspin transcript in peripheral blood. Of note, 3 of 9 patients with stage IV breast cancer receiving systemic therapy at the time of sample collection, but only 1 of 11 patients with stage IV not receiving therapy, had detectable maspin transcript in peripheral blood. Moreover, 3 marrow specimens from stage IV patients tested positive by this assay. CONCLUSIONS: This pilot study suggests that maspin RT-PCR assay is a sensitive, specific and sufficiently rapid method for detection of small numbers of circulating cells and marrow micrometastases in breast cancer patients. The possibility of applying this assay in the detection of tumor cell contamination of both marrow and stem-cell apheresis harvests of breast cancer patients merits further investigation.

Breast Neoplasms↗

Clonal origin of a T cell lymphoproliferative malignancy.

A woman with a T cell lymphoproliferative malignacy and heterozhgosity at the X chromosome-linked locus for glucose-6-phosphate dehydrogenase (G-6PD) isoenzymes was studied to find the clonal origin of her circulating neoplastic T cells. The red blood cells, polymorphonuclear cells, whole mononuclear cells, and T cell-depleted mononuclear cells contained both A and B isoenzymes of G-6-PD. In contrast, the tumor cells, separated by using their capacity to form rosettes with sheep red blood cells, contained only the B isoenzyme of G-6-PD. This observation strongly suggests the monoclonality of this T cell malignancy.

Adult↗

Detection of circulating melanoma cells by immunomagnetic cell sorting.

We developed a cellular approach to the identification of circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. One hundred seventy-eight blood samples from 129 melanoma patients and 30 samples from healthy persons and nonmelanoma patients were examined. After density gradient centrifugation the interphase was incubated with the mAb 9.2.27. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-antialkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per ml whole blood could be detected reliably with the assay. Circulating melanoma cells were not found in 30 controls examined, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and in patients with disseminated disease, circulating 9.2.27-positive cells could be detected in 3 out of 22 patients (13.6%) and 10 out of 66 patients (15.2%) examined. We present a sensitive and specific immunocytological approach to detect circulating melanoma cells in peripheral blood. The method is not suitable for early detection of metastases but is a valuable tool for further investigating biological characteristics of circulating melanoma cells.

Antibodies↗

Will differential culturing of circulating human lung cancer cells aid in understanding metastasis?

It is thought that there is need to resolve the incompatibilities present in current concepts of cancer metastasis. In presenting as many as 10 such anomalies in lung cancer dissemination in this Journal, my explanatory hypothesis rested on the contradistinctive status of the blood-borne and lymph-borne lung cancer cell (LCC). Perhaps, researches slanted towards differential culturing of these two circulating cells will open avenues for advancing the bioscience of cell transportation in human cancer metastasis.

Humans↗

[Clinical significance of identification and characterization of circulating tumor cells].

BACKGROUND: Cancer is characterized by the fact that years after the primary curative treatment metastases might develop. Due to the good vascularisation of primary tumors single cells might drip into the blood vessels and get a chance to reach other organs including the bone marrow. This means that there is always the possibility that metastases develop. IDENTIFICATION OF TUMOR CELLS: Disseminating tumor cells have their characteristic patterns of somatic mutations. This means that they can be identified and characterized by molecular-genetic techniques. They can be studied with regard to their origin and their ability to metastasize. Furthermore, their sensitivity or resistance with regard to chemotherapy can be identified. CLINICAL SIGNIFICANCE: In order to study circulating tumor cells these have to be extracted from peripheral blood. The first step is to isolate mononucleated cells from the blood. The second step is to separate the normal blood cells from other mononucleated cells. The third step is to extract and analyse DNA and RNA from these cells focussing on specific mutations of oncogenes and tumor suppressor genes. ANALYSES: The identification of circulating tumor cells helps to identify suspect clinical results, reveals minimal residual disease and might support individual therapeutic strategies.

Cell Transformation, Neoplastic↗

Bone marrow angiogenesis and circulating plasma cells in multiple myeloma.

Bone marrow (BM) angiogenesis is increased in multiple myeloma (MM) and has prognostic significance. The presence of circulating plasma cells (PCs) in MM is associated with a poorer prognosis. We examined BM biopsies obtained at diagnosis of MM for angiogenesis, and correlated the microvessel density (MVD) with the presence of circulating PCs. There was a positive correlation between the absolute number of circulating PCs and the mean MVD. This relationship was independent of the disease activity and of the PC burden in the marrow. The increased angiogenesis may promote plasma cell proliferation and enable PC migration into the circulation.

Bone Marrow↗

[Leiomyosarcoma of the inferior vena cava. Diagnosis--therapy--prognosis].

Leiomyosarcoma of the vena cava inferior is a mesenchymal tumor originating from the smooth muscle fibers of the vascular wall. This tumor is usually slow-growing and expansile growth. Prior to the sonographic and computer-tomographic era the tumor was usually only discovered during autopsy or surgery without any preoperative suspicion. Today, the most efficient imaging methods for exact localization, delineation or demonstration of relations to the vascular lumen and local extent are sonography and computer tomography. Caudal cavography is called upon for preoperative demonstration of the venous collateral circulation and thrombotic vascular occlusion.

Biopsy, Needle↗

Interactions between cancer cells and the endothelium in metastasis.

The haematogenous phase of cancer metastasis facilitates the transport of metastatic cells within the blood and incorporates a sequence of interactions between circulating intravascular cancer cells and the endothelium of blood vessels at the sites of tumour cell arrest. Initial interactions involve mechanical contact and transient adhesion, mediated by endothelial selectins and their ligands on the neoplastic cells. This contact initiates a sequence of activation pathways that involves cytokines, growth factors, bioactive lipids, and reactive oxygen species produced by either the cancer cell or the endothelium. These molecules elicit expression of integrin adhesion molecules in cancer cells and the endothelium, matrix metalloproteinases, and chemotactic factors that promote the attachment of tumour cells to the vessel wall and/or transvascular penetration. Induction of endothelial free radicals can be cytotoxic to cancer cells. Collectively, the sum of these interactions constitutes an interdependent relationship, the outcome of which determines the fate of the metastatic process.

Animals↗