Bone marrow micrometastases in 109 breast cancer patients: correlations with clinical and pathological features and prognosis.
BACKGROUND
The presence in bone marrow of cells which react with monoclonal antibodies against tumor-associated antigens has been proposed over the last few years as a new prognostic factor in breast cancer patients.


METHODS
Bone marrow aspirates were obtained from 109 stage I and II breast cancer patients during or 2-4 weeks after primary surgery. The samples were processed for leukocyte separation on a Ficoll-Hypaque gradient and then used to prepare cytospin slides for immunocytochemical analysis. The slides were stained with a pool of monoclonal antibodies (MoAbs) which recognize tumor associated antigens, using the alkaline phosphatase anti-alkaline phosphatase method. The median follow-up was 36 months (range 15-62): 22 patients relapsed and 7 died.


RESULTS
Thirty-four of the 109 patients (31.1%) had MoAb positive bone marrow cells. The bone marrow was positive in 28/74 (37.9%) patients who had the aspirate taken during surgery and in 6/35 (17.1%) who had it taken after surgery (p = 0.055). No association was found between bone marrow positivity and tumour size, nodal status, menopausal status, estrogen receptor positivity or the proliferative index. No association was found between bone marrow and prognosis: the log-rank test was 0.291 (p > 0.5) for OS and 0.023 for DFS; the hazard ratio (positive vs negative) was 1.51 for OS (95% CI: 0.33-6.86) and 0.93 for DFS (95% CI: 0.35-2.45).


CONCLUSIONS
In our series, bone marrow positivity did not correlate with prognostic parameters or prognosis. Of interest is the relative excess of positivity when the bone marrow was obtained during surgery.
Molino
A
A
Department of Medical Oncology, University of Verona, Italy.
Pelosi
G
G
Turazza
M
M
Sperotto
L
L
Bonetti
A
A
Nortilli
R
R
Fattovich
G
G
Alaimo
C
C
Piubello
Q
Q
Pavanel
F
F
Micciolo
R
R
Cetto
G L
GL
D000911:Antibodies, Monoclonal; D019046:Bone Marrow Neoplasms / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis
D000911:Antibodies, Monoclonal; D011960:Receptors, Estrogen