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World J Gastroenterol. Aug 14, 2014; 20(30): 10296-10304
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10296
Prognostic relevance of minimal residual disease in colorectal cancer
Ulrich Bork, Robert Grützmann, Nuh N Rahbari, Sebastian Schölch, Marius Distler, Christoph Reissfelder, Moritz Koch, Jürgen Weitz
Ulrich Bork, Robert Grützmann, Nuh N Rahbari, Sebastian Schölch, Marius Distler, Christoph Reissfelder, Moritz Koch, Jürgen Weitz, Department of GI, Thoracic and Vascular Surgery, University Hospital Dresden, TU Dresden, 01307 Dresden, Germany
Author contributions: Bork U and Grützmann R contributed equally to this article; all the authors approved the final version.
Correspondence to: Ulrich Bork, MD, Department of GI, Thoracic and Vascular Surgery, University Hospital Dresden, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany. ulrich.bork@uniklinikum-dresden.de
Telephone: +49-351-4582742  Fax: +49-351-4584395
Received: November 15, 2013
Revised: December 18, 2013
Accepted: April 27, 2014
Published online: August 14, 2014
Abstract

Presence of occult minimal residual disease in patients with colorectal cancer (CRC) has a strong prognostic impact on survival. Minimal residual disease plays a major role in disease relapse and formation of metastases in CRC. Analysis of circulating tumor cells (CTC) in the blood is increasingly used in clinical practice for disease monitoring of CRC patients. In this review article the role of CTC, disseminated tumor cells (DTC) in the bone marrow and micrometastases and isolated tumor cells (ITC) in the lymph nodes will be discussed, including literature published until September 2013. Occult disease is a strong prognostic marker for patient survival in CRC and defined by the presence of CTC in the blood, DTC in the bone marrow and/or micrometastases and ITC in the lymph nodes. Minimal residual disease could be used in the future to identify patient groups at risk, who might benefit from individualized treatment options.

Keywords: Colorectal cancer, Circulating tumor cells, Disseminated tumor cells, Isolated tumor cells, Micrometastases, Occult disease, Minimal residual disease

Core tip: Occult disease or minimal residual disease is defined by the presence of tumor cells in the blood, bone marrow or lymph nodes not found in conventional staging procedures. Occult disease in form of circulating tumor cells in the blood, disseminated tumor cells in the bone marrow and micrometastases and isolated tumor cells in the lymph nodes is a prognostic marker for survival in colorectal cancer. Future research should be directed to test the predictive value of occult disease as an additional staging tool to identify high risk patients. The patient group at risk might benefit from additional individualized treatment options and this should be investigated in future clinical trials.