Abstract
The prognostic significance of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients at the time of primary diagnosis has been confirmed by a large pooled analysis. In view of the lack of early indicators for secondary adjuvant treatment, we here evaluated whether the persistence of DTCs after adjuvant therapy increases the risk of subsequent relapse and death. Individual patient data from 676 women with primary diagnosis of early breast cancer stages I-III from 3 follow-up studies were pooled. During clinical follow-up, patients underwent BM aspiration (BMA) to determine the presence of DTC. Tumor cells were detected by the standardized immunoassays. Univariate and multivariable proportional hazards models were estimated to assess the prognostic significance of DTC for disease-free survival (DFS) and overall survival (OS). Patients were followed for a median of 89 months. BMA was performed at median 37 months after diagnosis of breast cancer. At follow-up BMA, 15.5% of patients had DTCs. The presence of DTC was an independent indicator of poor prognosis for DFS, distant DFS (DDFS), cancer-specific survival, and OS during the first 5 years following cancer diagnosis (log-rank test P < 0.001 values for all investigated endpoints). Among breast cancer patients, persistent DTCs during follow-up significantly predicted the increased risk for subsequent relapse and death. Analysis of DTC might serve as a clinically useful monitoring tool and should be tested as an indicator for secondary adjuvant treatment intervention within clinical trials.
Highlights
Disseminated tumor cells (DTC) can be detected in the bone marrow (BM) up to 30% to 40% of breast cancer patients [1,2,3,4,5]
The presence of disseminated tumor cells (DTC) was an independent indicator of poor prognosis for disease-free survival (DFS), distant DFS (DDFS), cancer-specific survival, and overall survival (OS) during the first 5 years following cancer diagnosis
Our findings suggest that BM aspirations may serve as a future monitoring tool during the follow-up of breast cancer patients
Summary
Disseminated tumor cells (DTC) can be detected in the bone marrow (BM) up to 30% to 40% of breast cancer patients [1,2,3,4,5]. The strong independent prognostic significance of DTCs at the time of primary diagnosis has already. Authors' Affiliations: 1Frauenklinik der Heinrich-Heine-Universitat, Düsseldorf, 2Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, 3Frauenklinik Innenstadt der LMU München, München, 4Institut für Tumorbiologie, UKE, Hamburg, Germany; 5Breast Health Center, Hospital "F. Tappeiner," Merano, Italy; Departments of 6Gastrointestinal Surgery and 7Oncology, and 8Division of Pathology, Oslo University Hospital, The Radium Hospital, University of Oslo, Oslo, Norway; 9Universitaetsklinikum fuer Frauenheilkunde, Leopold-Franzens-Universitaet, Innsbruck, Austria. The prognostic significance of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients at the time of primary diagnosis has been confirmed by a large pooled analysis. In view of the lack of early indicators for secondary adjuvant treatment, we here evaluated whether the persistence of DTCs after adjuvant therapy increases the risk of subsequent relapse and death
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