Predictive value of clinical and laboratory findings for overt bone marrow metastasis in patients with solid tumor.

Abstract

e19529 Background: Bone marrow (BM) involvement is not a rare finding in advanced stages of solid tumors, it may have a profound influence on prognosis and affect a treatment approach. Methods: 103 patients (pts) with an advanced metastatic solid tumor were included in retrospective study. BM metastasis were diagnosed in 72 cases according to Bone marrow biopsy (BMB) ; 31 other metastatic pts. didn't have a marrow spread. We analyzed a basic demographic characteristics, localization of primary tumors and metastasis, laboratory tests, blood smears, BM aspirates (BMA) and biopsies reports.Results: Pts in both groups had comparable median age, gender distribution, pattern of primary tumor and metastatic spread. Hematological parameters' strong correlated with marrow metastasis were: anemia 83% vs. 61% p=0.015 ,thrombocytopenia 55% vs.16% p<0.001 with higher MPV p=0.01, hypocellular/ dry tap marrow aspirate 58% vs.14% p=0.001 and leukoerythroblastic blood smear 82% vs.0% p<0.0001. Leukoerythroblastosis(LEB) in 92% reflected hypocellular aspirate was not included in final analysis because of low rate recorder blood smears. Analysis of biochemical finding showed higher increase by 2 upper limits (>2ULN) of LDH and ALP in the metastatic BM cohort: 50% vs. 16% and 35% vs. 9%, p=0.002 and p=0.007 respectively. Factors predicted metastatic BM by multivariate analysis were: thrombocytopenia <50x109/L OR 14.4 95%CI (1.6-128), hypocellular BMA OR 7.0 95%CI (1.82-21.2) and alkaline phosphatase >2ULN levels OR 6.5 95%CI ( 1.2-35.3). Causes which influenced the survival of pts with BM metastasis: thrombocytopenia < 50X109/ L median survival 0.8 month 95% CI (0.1-1.5) vs. 4.1m 95%CI( 2.0-6.1), LDH level >2ULN 1.8m 95%CI(0.5-3.0) vs.4.7m 95%CI(3.0-6.3) and tumor presenting with BM metastasis vs. previously recognized carcinoma with BM involvement 1.8m 95% CI(0.3-3.0) vs.4.0 m.95%CI(1.3-6.7).Conclusions: Our study demonstrated that thrombocytopenia , alkaline phosphatase level>2ULN and probably LEB reflect hypoplastic BM predict BM metastasis in cancer patients; furthermore, thrombocytopenia, LDH>2ULN and BM metastasis in a clinical presentation affect their survival.