Tumour cell detection in the bone marrow of breast cancer patients at primary therapy: results of a 3-year median follow-up.
We examined bone marrow aspirates from 100 metastasis-free primary breast cancer patients. In 38/100 patients (38%), tumour cells were detected in the marrow using an immunocytochemical technique with a cocktail of two monoclonal antibodies: anti-EMA and anti-cytokeratin. Median follow-up was 34 months: 15/38 (39%) tumour cell-positive patients have since relapsed, but only 9/62 (15%) tumour cell-negative patients. The median interval between tumour cell detection and relapse was 11.4 months. No statistically significant correlation existed between tumour cell presence and 'established' prognostic factors. However, relapse-free survival was significantly shorter in tumour cell-positive patients. Multivariate analysis showed tumour cell presence as a strong, significant prognostic factor for relapse-free as well as overall survival. We conclude that screening for tumour cells in bone marrow of primary breast cancer patients identifies high-risk patients for early relapse. In particular, patients with node-negative tumours who have tumour cells in their bone marrow may require subsequent systemic therapy.
Harbeck
N
N
Department of Obstetrics and Gynaecology, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany.
Untch
M
M
Pache
L
L
Eiermann
W
W
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D001853:Bone Marrow / Q000473:pathology*; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012008:Recurrence; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors
D000911:Antibodies, Monoclonal; D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D013629:Tamoxifen; D007633:Keratins; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate