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Ann Thorac Surg 2004;78:1950
© 2004 The Society of Thoracic Surgeons

INVITED COMMENTARY

Masaki Tomita, MD

Department of Surgery II, Miyazaki Medical College, Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan

mtomita{at}post.miyazaki-med.ac.jp

Several studies have demonstrated that bone marrow micrometastases (BMMs) in patients with malignancies is an independent prognostic factor for systemic recurrence and poorer survival. These results of studies of BMMs detection support the concept that systemic spread may happen at an early stage in esophageal cancer. Such systemic spread is often occult at the time of primary diagnosis, which may have adverse effects on survival. This hypothesis is easy to understand. However the present study contains some incomprehensible results.

The present results reported that detection of BMMs was associated with lymphovascular invasion (LVI) but not N status. Authors speculated that the reason for the results might be due to alternative pathways for tumor spread. However, some previous studies demonstrated a significant correlation between LVI and N status in esophageal cancer. Therefore the relationship among BMMs, LVI, and N status is difficult to understand.

The presence of BMM was reported to be closely related to tumor angiogenesis. However the present results indicated that the relationship between BMM and intratumor microvessel density (IMD) was not found in overall and squamous cell carcinoma patients, but was found in adenocarcinoma patients. This result might be due to different characteristics of esophageal adenocarcinoma and squamous cell carcinoma.

Although esophageal adenocarcinoma and squamous cell carcinoma have different characteristics, most of the data were investigated using both histologic subtypes. Therefore, the possibility remains that author's results would be different if authors use these two histologic subtypes separately.

Unfortunately, the clinical significance of the detection of BMMs cannot be concluded from this study. Although the significance of BMMs remains controversial, there is increasing evidence that BMMs provides useful prognostic information. As commented by authors, further study is required to clarify whether detection of BMMs at time of surgery has independent prognostic significance.


Related Article

Bone Marrow Micrometastases and Markers of Angiogenesis in Esophageal Cancer
Gary M. Spence, Alastair N. J. Graham, Kathleen Mulholland, Perry Maxwell, W. Glenn McCluggage, James M. Sloan, and James A. McGuigan
Ann. Thorac. Surg. 2004 78: 1944-1949. [Abstract] [Full Text] [PDF]




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