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Molecular Detection of Cytokeratin-19–Positive Cells in the Peripheral Blood of Patients With Operable Breast Cancer: Evaluation of Their Prognostic Significance

From the Laboratory of Tumor Cell Biology and Department of Biostatistics, School of Medicine, University of Crete, and Department of Medical Oncology, University General Hospital of Heraklion, Heraklion; and Medical Oncology Unit, Elena Venizelou Hospital, Athens, Greece.

Address reprint requests to Vassilis Georgoulias, MD, PhD, Department of Medical Oncology, University General Hospital of Heraklion, PO Box 1352, 711 10 Heraklion, Crete, Greece; email: georgoul{at}med.uoc.gr

PURPOSE: To evaluate the prognostic significance of molecular detection of cytokeratin 19 (CK-19) mRNA-positive cells by nested reverse transcriptase polymerase chain reaction (RT-PCR) in the peripheral blood of women with stages I and II breast cancer before adjuvant chemotherapy.

PATIENTS AND METHODS: The sensitivity and specificity of CK-19 mRNA detection by nested RT-PCR were investigated using MCF-7 and ARH-77 cells and blood from healthy women and patients with hematologic malignancies, metastatic colorectal cancer, and early and metastatic breast cancer. Peripheral blood from 148 patients with operable breast cancer, obtained before initiation of any adjuvant therapy, was tested for the presence of CK-19 mRNA-positive cells.

RESULTS: The nested RT-PCR assay for CK-19 mRNA detected one MCF-7 tumor cell in 10⁶ normal peripheral blood mononuclear cells in four of five experiments; no signal was detected with the CK-19–negative ARH-77 cells. CK-19 mRNA was detected in the peripheral blood of 3.7% of healthy blood donors, 14.3% of patients with hematologic malignancies, and 3.2% of patients with metastatic colorectal cancer. Detection rates for CK-19 mRNA-positive cells in the bone marrow/blood of patients with early or metastatic breast cancer were 63%/30% and 74%/52%, respectively. For stages I and II breast cancer, detection of CK-19–positive cells in the peripheral blood before adjuvant therapy was associated with reduced disease-free interval (P = .0007) and overall survival (P = .01). In multivariate analysis, detection of peripheral-blood CK-19–positive cells was an independent prognostic factor for disease relapse and death.

CONCLUSION: Molecular detection of CK-19 mRNA-positive cells by RT-PCR in the peripheral blood of patients with stages I and II breast cancer before initiation of adjuvant therapy has independent prognostic value as a marker of poor clinical outcome.

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