Evaluation of bone-marrow micrometastasis effects on disease course in patients with esophageal cancer
Evaluation of bone-marrow micrometastasis effects on disease course in patients with esophageal cancer
Mahdi Zarei,1,*
1. Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Introduction: Esophageal cancer is a type of invasive malignancy in which the risk of the involvement of blood vessels and lymph nodes at the time of diagnosis is high. The presence of metastasis in this malignancy can strongly affect the prognosis of the disease; however, some patients, despite not having detectable metastasis in the primary surgery, have shown recurrence due to the presence of micrometastasis. Bone marrow specimen immunohistochemistry (IHC) evaluation and anti-cytokeratin 18 antibody staining, which were obtained from the rib resection of patients with esophageal cancer, show that up to 90% of the cases have malignant cells. This study aimed to evaluate the association between bone marrow micrometastasis and histopathological and clinical behaviors of the tumor by comparing patients with or without bone marrow micrometastasis, followed by comparing neoadjuvant chemotherapy and surgery versus surgery alone in the prognosis of these patients.
Methods: This study reviewed the published literature on the association of bone marrow micrometastasis with the pathological behavior of the tumor and the application of neoadjuvant chemotherapy for the control of micrometastasis. The results and relevant parameters involved in this subject were evaluated. The published literature on PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were used for the study.
Results: Approximately 53% of bone marrow micrometastasis cases do not have any significant differences in clinical signs in comparison to other patients. On the other hand, in some studies, there was a significant relationship between the presence of bone marrow micrometastatic cells with the tumor grade and stage N of the tumor. Nevertheless, there was no significant relationship between age, gender, and tumor length with micrometastasis. Additionally, the ten-year survival rate was 20% for those who only underwent surgery and 28% for those who underwent neoadjuvant chemotherapy followed by surgery, which was due to the micrometastasis reduction by neoadjuvant chemotherapy
Conclusion: Conclusion: Due to the critical role of bone marrow micrometastasis in determining the prognosis of this malignancy and its significant association with the tumor grade and stage N of the tumor, it is required to carry out further studies with IHC or hematoxylin-eosin staining and neoadjuvant chemotherapy.