Prediction of tumor cell dissemination in primary breast cancer by tumor biological and clinicopathological factors

Abstract

661 Background: The presence of disseminated tumor cells in bone marrow (BM) of primary breast cancer patients is associated with poor prognosis and may therefore be related with aggressive breast cancer and high tumor load as indicated by tumorbiological and clinicopathological features. The aim of this study was to identify those features related to the presence and number of disseminated tumor cells in BM. Methods: Clinical data from 360 primary breast cancer patients who underwent surgery and received a bone marrow aspiration between 2001 and 2003 at the Dept. of Gyn/OB, University of Tübingen, Germany were analyzed. Tumorbiological features of the primary tumor including HER2, p53, ki-67, bcl-2, estrogen and progesterone receptor status as well as clinicopathological factors including histology, menopausal status, lymph node status, tumor size and grade were studied for their association with BM involvement by univariate (Chi-squared test) and multivariate analysis (logistic regression). The relationship between the number of disseminated tumor cells and tumorbiological and clinicopathological factors were evaluated by Mann-Whitney-U-test. Results: 142 of 360 (39%) of the primary breast cancer patients had disseminated tumor cells in the BM. The number of tumor cells in bone marrow-positive patients ranged from 1 to 35 tumor cells. Histological grade, p53, estrogen receptor status and ki-67 were significantly related to BM involvement and the number of disseminated tumor cells. No association could be observed for all other factors. The multivariate analysis revealed that grade (OR: 1.9, 95%-CI:1.1–3.5) and estrogen receptor status (OR: 2,5, 95%-CI: 1.4–4.4) were the only independent determinants for BM involvement. Conclusion: Tumor grade and estrogen receptor status were the only reliable indicators of the likelihood of tumor cell dissemination in BM. The presence of disseminated tumor cell in the BM was not influenced by tumor load as reflected by tumor size and lymph node status. No significant financial relationships to disclose.