title: Primary systemic therapy does not eradicate disseminated tumor cells in breast cancer patients.
abstract: BACKGROUND
  The presence of disseminated tumor cells in the bone marrow of breast cancer patients has proven to be an independent prognostic factor. The aim of this study was to investigate the status of tumor cell dissemination after primary systemic therapy in relation to therapy response.
  
  
  METHODS
  Bone marrow aspirates were obtained from 120 patients after completion of primary systemic therapy. Disseminated tumor cells were detected by immunocytochemistry using the APAAP method. Bone marrow status was correlated with clinicopathological factors as well as tumor response to primary systemic therapy.
  
  
  RESULTS
  Sixty out of 120 patients had disseminated tumor cells in their bone marrow aspirates (50%). Response rates were 18% for pathologic complete remission, 52% for partial remission, 28% for no change and 3% for progression. Despite complete remission, 36% of these patients were bone marrow positive. In the partial remission group, the positivity rate was 48%. About 61% of patients with stable disease had disseminated tumor cells in their bone marrow. A trend to higher positivity rates was observed in the poor responder group compared to responders (61% vs. 38%, P = 0.1).
  
  
  CONCLUSIONS
  Primary systemic therapy does not completely eradicate disseminated tumor cells in the bone marrow of breast cancer patients. The biological role of persistent disseminated tumor cells needs to be further investigated to optimize current and future therapeutic strategies.
authors.affiliation: Department of Gynecology and Obstetrics, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany. sven.becker@med.uni-tuebingen.de
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
authors.forename: Erich
authors.initials: E
authors.lastname: Solomayer
authors.forename: Graziella
authors.initials: G
authors.lastname: Becker-Pergola
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011379:Prognosis; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors