title: Circulating tumor cells in newly diagnosed inflammatory breast cancer.
abstract: BACKGROUND
  Circulating tumor cells (CTCs) are an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer. Inflammatory breast cancer (IBC) is one of the most aggressive forms of breast cancer. The prognostic value of a CTC count in newly diagnosed IBC has not been established. The aim of this study was to assess the prognostic value of a baseline CTC count in patients with newly diagnosed IBC.
  
  
  METHODS
  This retrospective study included 147 patients with newly diagnosed IBC (77 with locally advanced and 70 with metastatic IBC) treated with neoadjuvant therapy or first-line chemotherapy during the period from January 2004 through December 2012 at The University of Texas MD Anderson Cancer Center. CTCs were detected and enumerated by using the CellSearch system before patients were started with chemotherapy.
  
  
  RESULTS
  The proportion of patients with ≥1 CTC was lower among patients with stage III than among patients with metastatic IBC (54.5% versus 84.3%; P=0.0002); the proportion of patients with ≥5 CTCs was also lower for stage III than for metastatic IBC (19.5% versus 47.1%; P=0.0004). Patients with fewer than five CTCs had significantly better progression-free survival (PFS) (hazard ratio (HR)=0.60; P=0.02) and overall survival (HR=0.59; P=0.03) than patients with five or more CTCs. Among patients with stage III IBC, there was a nonsignificant difference in PFS (HR=0.66; 95% confidence interval (CI), 0.31 to 1.39; P=0.29) and OS (HR=0.54; 95% CI, 0.24 to 1.26; P=0.48) in patients with no CTCs compared with patients with one or more CTCs. In multivariate analysis, CTC was prognostic for PFS and OS independent of clinical stage.
  
  
  CONCLUSIONS
  CTCs can be detected in a large proportion of patients with newly diagnosed IBC and are a strong predictor of worse prognosis in patients with newly diagnosed IBC.
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. misomego@gmail.com.|Department of Medical Oncology, Comenius University, School of Medicine, Bratislava, Slovakia. misomego@gmail.com.|Present affiliation: Breast Center, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA, USA. misomego@gmail.com.
authors.forename: Michal
authors.initials: M
authors.lastname: Mego
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. agiordanomd@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. u_degiorgi@yahoo.com.|Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, FC, Italy. u_degiorgi@yahoo.com.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. hmasuda@onh.go.jp.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. lhsu@mdanderson.org.
authors.forename: Limin
authors.initials: L
authors.lastname: Hsu
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. giuliano@bcm.edu.|Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy. giuliano@bcm.edu.
authors.forename: Mario
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. TFouad@mdanderson.org.
authors.forename: Tamer M
authors.initials: TM
authors.lastname: Fouad
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. sdawood@yahoo.com.|Medical Oncology Department, Dubai Hospital, Dubai, UAE. sdawood@yahoo.com.
authors.forename: Shaheenah
authors.initials: S
authors.lastname: Dawood
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. nueno@mdanderson.org.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. nueno@mdanderson.org.
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. vvalero@mdanderson.org.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. vvalero@mdanderson.org.
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. eandreop@mdanderson.org.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. eandreop@mdanderson.org.
authors.forename: Eleni
authors.initials: E
authors.lastname: Andreopoulou
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ralvarez@mdanderson.org.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ralvarez@mdanderson.org.
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Alvarez
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. wwoodward@mdanderson.org.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ghortoba@mdanderson.org.
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.affiliation: Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Massimo.Cristofanilli@jefferson.edu.|Present affiliation: Breast Center, Thomas Jefferson University-Kimmel Cancer Center, Philadelphia, PA, USA. Massimo.Cristofanilli@jefferson.edu.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cristofanilli
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. jreuben@mdanderson.org.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jreuben@mdanderson.org.
authors.forename: James M
authors.initials: JM
authors.lastname: Reuben
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D058922:Inflammatory Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors