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Detection and clinical implications of minimal residual disease in gastro-intestinal cancer

  • New Surgical Horizons
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Abstract

Introduction

Metastatic dissemination is an important factor for the prognosis of patients with gastro-intestinal cancer. Exact staging is crucial to determine appropriate multimodal therapeutic strategies. At present, the sensitivity of routinely performed diagnostic techniques is suboptimal for the detection of minimal residual disease (MRD) and occult metastases since the number of disseminated tumour cells (DTCs) is mostly marginal. To amend the verification of DTCs, immunohistochemical and molecular methods were applied to retrieve epithelial cell-specific proteins in non-epithelial tissue of different body compartments or fluids. Many groups have eagerly focussed on the identification of new markers and novel tests, yet specificity and sensitivity of these methods as well as robustness in the clinical setting are frequently missing.

Materials and methods

This review critically evaluates the prognostic impact of MRD in patients with pancreatic, colorectal and gastric cancer by outlining those studies showing diagnostic results of DTC detection in lymph nodes, bone marrow, venous blood and peritoneal lavage, some of which present novel strategies.

Conclusion

The analysed data concerning MRD in gastro-intestinal cancers reveal that results are undesirably heterogeneous. From a critical point of view, many clinical studies missed their chance because of small cohort size; moreover, methodological standardisation is generally lacking. On the other hand, the very encouraging results achieved so far, together with the comprehensive analyses of a few research groups, foster the prediction that DTC/MRD issues will soon expand the standard TNM classification.

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Acknowledgements

Major projects of the authors on MRD/DTC have been supported by the “Deutsche Krebshilfe eV” and intramural funding by the Medical Faculty, University Kiel, as well as by the “Schleswig-Holsteinische Krebsgesellschaft eV”. The scientific and technical support by Christian Röder, Edlyn Soeth, Bianca Körtge, Bianca Zinke, and Alexandra Sieger is gratefully appreciated.

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  1. Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105, Kiel, Germany

    Fabian Wolfrum, Fred Fändrich & Holger Kalthoff

  2. Department of General Surgery, Municipal Hospital Kiel, Chemnitzstrasse 33, 24116, Kiel, Germany

    Ilka Vogel

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  1. Fabian Wolfrum
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Correspondence to Holger Kalthoff.

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Wolfrum, F., Vogel, I., Fändrich, F. et al. Detection and clinical implications of minimal residual disease in gastro-intestinal cancer. Langenbecks Arch Surg 390, 430–441 (2005). https://doi.org/10.1007/s00423-005-0558-3

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