Rating of isolated disseminated tumor cells in bone marrow in comparison with other factors of prognosis in breast carcinoma.
BACKGROUND
Despite the use of radical loco-regional therapeutic methods and although conventional methods of diagnosis give no indication of metastases at the time of operation, distant metastases develop in approximately 50 percent of the carcinoma patients within 5 years. While with the R0 resection of solid tumors local relapses are mainly a matter of concern for the operating surgeon, distant metastases can be traced back to systemic dissemination of tumor cells at the time of operation.


OBJECTIVE
The goal of our prospective six year continuous study is to compare the rating of the IDT BM with established prognosis factors and to reach conclusions for the practice.


METHODS
A prospective study is represented in which 197 patients suffering from breast carcinoma were analyzed for prognostic relevance of detected isolated disseminated tumor cells in the bone marrow (IDT BM). The patients were operated between 1993-1997 and subsequently observed until 1999. The monoclonal antibodies CK II and A45-B/B3 were used with the immuno-cytochemical standard method for detecting IDT BM. For the purpose of cell cultivation, the cells were marked with the HEA 125 antibody and separated by means of magnetic cell sorting (MACS). In this investigation, only the presence of isolated disseminated tumor cells detected by the


RESULTS
A45-B/B3 antibody proved to be an independent prognostic factor for survival time. The risk of an earlier death increased with the detection of IDT BM at least by a factor of two. The detection of IDT BM also represented an independent prognostic factor for the time until advancement of the tumor. The risk of an earlier relapse of the tumor increased with the detection of disseminated tumor cells in the bone marrow containing the A45-B/B3 antibody by at least a factor of four.


CONCLUSIONS
A generally acknowledged standardization of the method is desirable. Due to the importance of the independent prognostic IDT BM factor, this method of ascertaining the pathological stage should be established at institutions of higher learning.
Leinung
S
S
Chirurgische Klinik I, Universität Leipzig. leinungs@medizin.uni-leipzig.de
Würl
P
P
Schönfelder
A
A
Weiss
C L
CL
Röder
I
I
Schönfelder
M
M
D000368:Aged; D000911:Antibodies, Monoclonal; D001853:Bone Marrow / Q000473:pathology*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007633:Keratins / Q000378:metabolism*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D009360:Neoplastic Cells, Circulating / Q000145:classification*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D007633:Keratins