BACKGROUND: It recently became evident that @entity5 cells undetectable by conventional @entity5 staging are frequently present in bone marrow of @entity1 with apparently localized @entity1149 ( @entity1149 ). The clinical relevance of this minimal @entity5 cell dissemination is under vigorous debate. METHODS: For @entity5 cell detection in the bone marrow, we used monoclonal antibody CK2 against the epithelial intermediate filament protein @entity2873 . The influence of a positive bone marrow finding on clinical outcome was studied in 139 @entity1 with @entity1149 postoperatively staged as pT1-4, pN0-2, M0, and R0 after a median follow-up of 66 months (range 48 to 74 months). RESULTS: Cytokeratin-18-positive cells in bone marrow were demonstrated in 83 (59.7%) @entity1 at the time of primary surgery and in 6 of 12 representative @entity1 analyzed twice 3 to 18 months after surgery. In @entity1 without histopathological lymph node metastases (pN0; n = 66), the occurrence of 2 or more @entity5 cells in bone marrow at primary surgery was a strong and independent predictor for overall survival (p = 0.007) in univariate analysis. The multivariate analysis showed a 2.8 times increased risk for shorter survival in @entity1 with disseminated @entity5 cells versus @entity1 without such cells. Four of the 6 @entity1 with a positive cytokeratin status after surgery developed a @entity5 recurrence 11 to 44 months after the operation, while none of the @entity1 with a negative bone marrow at all time intervals showed a @entity5 relapse. CONCLUSIONS: Minimal residual bone marrow involvement is an independent prognostic factor for overall survival in @entity1 with node-negative @entity1149 , which may help to identify @entity1 in need of an adjuvant systemic therapy. The postoperative persistence or reappearance of @entity5 cells in bone marrow indicates that these are not only shed cells but rather represent true micrometastasis.

@entity5 cells in bone marrow predict reduced survival in node-negative XXXX .

@entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'hematogenous tumor', 'isolated tumor'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity1149 :: ('MESH:D002289', 'Disease') :: ['NSCLC', 'non-small cell lung cancer'] @entity2873 :: ('3875', 'Gene') :: ['cytokeratin 18']
@entity1149 :: (MESH:D002289,Disease) :: ['non-small cell lung cancer']
