title: Prognostic relevance of disseminated tumor cells in the bone marrow and biological factors of 265 primary breast carcinomas.
abstract: BACKGROUND
  The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined 'tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow (BM) status for HER2, Topoisomerase IIalpha (Top IIa), Ki 67, and p53.
  
  
  METHODS
  BM analysis was performed by cytospin preparation and immunocytochemical staining for cytokeratin (CK). TMAs were examined by immunohistochemistry (IHC) for HER2, Top IIa, Ki 67 and p53, and fluorescence in situ hybridization (FISH) for HER2.
  
  
  RESULTS
  HER2 (2+/3+) was positive in 35/167 (21%) cases (FISH 24.3%), Top IIa (>10%) in 87/187 (46%), Ki 67 in 52/184 (28%) and p53 (>5%) in 61/174 cases (34%). Of 265 patients, 68 (25.7%) showed DTC-BM with a median of 2/2 x 106 cells (1 to 1,500). None of the examined factors significantly predicted BM positivity. Significant correlation was seen between HER2 IHC and Top IIa (p = 0.06), Ki 67 (p = 0.031), and p53 (p < .001). Top IIa correlated with Ki 67 and p53, and Ki 67 also with p53 (p = 0.004). After a median follow-up of 60.5 months (7 to 255), the presence of DTC-BM showed prognostic relevance for overall survival (p = 0.03), whereas HER2 (IHC, p = 0.04; FISH, p = 0.03) and Ki 67 (p = 0.04) correlated with disease free survival, and HER2 with distant disease free survival (IHC, p = 0.06; FISH, p = 0.05).
  
  
  CONCLUSIONS
  The congruence of the examined factors' expression rates indicates a causal line of suppressor, proliferation, and mitosis markers, and growth factor receptors. Hematogenous tumor cell spread seems to be an independent process. The examination of these factors on DTC-BM is the aim of ongoing research.
authors.affiliation: 1st Department of Obstetrics and Gynecology Klinikum, Ludwig-Maximilians-University, D-80337 Munich, Germany. Christian.Schindlbeck@med.uni-muenchen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schindlbeck
authors.forename: Theresa
authors.initials: T
authors.lastname: Kampik
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.forename: Brigitte
authors.initials: B
authors.lastname: Rack
authors.forename: Udo
authors.initials: U
authors.lastname: Jeschke
authors.forename: Stan
authors.initials: S
authors.lastname: Krajewski
authors.forename: Harald
authors.initials: H
authors.lastname: Sommer
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D019046:Bone Marrow Neoplasms / Q000235:genetics / Q000556:secondary*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology*; D002277:Carcinoma / Q000235:genetics / Q000556:secondary*; D049109:Cell Proliferation; D018572:Disease-Free Survival; D005260:Female; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008875:Middle Aged; D008938:Mitosis; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers