MIKROMETASTASEN IM KNOCHENMARK VON PATIENTEN MIT KARZINOMEN DES KOPF-HALS-BEREICHES

Individual disseminated epithelial tumour cells were detected in bone marrow aspirates in 41 of 108 patients (37%) with squamous cell cancer of the head and neck region by an immunocytochemical technique based on monoclonal antibodies raised against the cytokeratin No. 19. In the clinical stage I (T₁N₀M₀) tumour cells were detected only in 26,3% of the patients, whereas in stage IV (T₄N₀M₀, T(all)N_2-3M₀, T(all)N(all)M₁) almost twice as many patients (47,7%) presented with tumour cells in the bone marrow. Apparently, grade of differentiation of the tumour (grading) had no influence on the spread of single tumour cells. An influence of the different localisations of the primary tumour on tumour cell spread or the rate of tumour recurrence cannot as yet be discovered. Cytokeratin No. 19 expressing cells were not detectable in the bone marrow of 18 patients with non-malignant disease. Seventy-three patients were included in a follow-up study with a mean observation time of 25 months (range: 4-52 months). The presence of epithelial cells at the time of primary treatment appears to indicate a significantly higher risk of development of local or distant tumour recurrences (p = 0.01). Of 46 patients initially exhibiting no tumour cells in the bone marrow, only 14 had a clinical recurrence. Whereas 17 of 27 patients who presented with tumour cells in the bone marrow developed either a local tumour recurrence or distant metastases in different organs. Patients presenting with bone marrow tumour cells showed a significantly shorter disease-free survival than those without (p = 0,002). A Cox regression analysis suggests that the finding of occult tumour cells in the bone marrow is an independent, significant prognostic variable of a late clinical relapse (p = 0,01).