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Ann Thorac Surg 2003;76:194-201
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

Prognostic value of cytokeratin-positive cells in the bone marrow and lymph nodes of patients with resected nonsmall cell lung cancer: a multicenter prospective study

^a Department of Surgery II, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
^b Department of Surgery I, Kanazawa University School of Medicine, Kanazawa, Japan
^c Department of Surgery, Tokyo Medical University, Tokyo, Japan
^d Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan

Accepted for publication January 22, 2003.

^* Address reprint requests to Dr Yasumoto, Department of Surgery II, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
e-mail: k-yasumo{at}med.uoeh-u.ac.jp

BACKGROUND: This study was designed to prospectively substantiate the prognostic value of cytokeratin-positive (CK⁺) cells in the bone marrow (BM) and regional lymph nodes (LNs) in resected nonsmall cell lung cancer (NSCLC) patients from a large population within a multicenter study.

METHODS: The study population consisted of 351 patients with stages I to IIIA NSCLC from 15 Japanese institutes. BM aspirates were stained immunocytochemically with the anti-cytokeratin antibody, CK2. The hilar and mediastinal LNs of 216 patients with stage I NSCLC were stained immunohistochemically with the anti-CK antibody, AE1/AE3.

RESULTS: CK⁺ cells were detected in 112 patients (31.9%) of the 351 BM aspirate patients. The frequency of CK⁺ cells showed no differences among pathologic stages. The patients with CK⁺ cells in the BM had a tendency to have shorter survival periods than those without CK⁺ cells (p = 0.076). Although the presence of CK⁺ cells in the BM of patients with stage I did not allow the prediction of overall survival, it reduced the overall survival significantly in patients with stages II to IIIA. CK⁺ cells in the LNs were detected in 34 of 216 patients (15.7%) with stage I. The patients with CK⁺ cells in the LNs had a poor prognosis by both univariate (p = 0.004) and multivariate analyses (p = 0.018).

CONCLUSIONS: The presence of CK⁺ cells in the BM was related to a poor prognosis for patients with stages II to IIIA NSCLC; however, it did not predict the prognosis of patients with stage I. For stage I NSCLC, the detection of CK⁺ cells in the LNs implied a poor prognosis for the patients.

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