title: Different prognostic value of circulating and disseminated tumor cells in primary breast cancer: Influence of bisphosphonate intake?
abstract: Disseminated tumor cells (DTCs) in the bone marrow (BM) and circulating tumor cells (CTCs) in blood of breast cancer patients (pts) are known to correlate with worse outcome. Here we demonstrate a different prognostic value of DTCs and CTCs and explain these findings by early clodronate intake. CTCs (n = 376 pts) were determined using the AdnaTest BreastCancer (Qiagen Hannover GmbH, Germany) and DTCs (n = 525 pts) were analyzed by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. Clodronate intake was recommended in case of DTC-positivity. CTCs were detected in 22% and DTCs in 40% of the pts, respectively. DTCs were significantly associated with nodal status (p = 0.03), grading (p = 0.01), lymphangiosis (p = 0.03), PR status (p = 0.02) and clodronate intake (p < 0.0001), no significant associations were demonstrated for CTCs. CTCs significantly correlated with reduced PFS (p = 0.0227) and negative prognostic relevance was predominantly related to G2 tumors (p = 0.044), the lobular (p = 0.024) and the triple-negative subtype (p = 0.005), HR-negative pts (p = 0.001), postmenopausal women (p = 0.013) and patients who had received radiation therapy (p = 0.018). No prognostic significance was found for DTCs. Therefore early clodronate intake can improve prognosis of breast cancer patients and CTCs might be a high risk indicator for the onset of metastasis not limited to bone metastasis.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Kasimir-Bauer
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Reiter
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Bahriye
authors.initials: B
authors.lastname: Aktas
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Ann-Kathrin
authors.initials: AK
authors.lastname: Bittner
authors.affiliation: ACOMED Statistik, Fockestr. 57, D-04275 Leipzig, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Weber
authors.affiliation: ACOMED Statistik, Fockestr. 57, D-04275 Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Keller
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kimmig
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D004002:Clodronic Acid / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000187:drug effects / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D050071:Bone Density Conservation Agents; D004002:Clodronic Acid