Geburtshilfe Frauenheilkd 2014; 74 - PO_Onko07_01
DOI: 10.1055/s-0034-1388441

Disseminated tumor cells from the bone marrow of patients with metastatic breast cancer

A Hartkopf 1, D Stefanescu 1, M Wallwiener 2, M Hahn 1, EF Solomayer 3, S Becker 4, T Fehm 5, S Brucker 1, FA Taran 1
  • 1Universität Tübingen, Frauenklinik, Tübingen, Germany
  • 2Universität Heidelberg, Frauenklinik, Heidelberg, Germany
  • 3Universität Saarland, Frauenklinik, Homburg, Germany
  • 4Universität Frankfurt, Frauenklinik, Frankfurt, Germany
  • 5Universität Düsseldorf, Frauenklinik, Düsseldorf, Germany

Background: Disseminated tumor cells (DTCs) from bone marrow (BM) of primary breast cancer patients are an early indicator of hematogenous cancer spread. There is, however, few known about the role of DTCs in metastatic breast cancer (MBC).

Methods: The DTC-Status was evaluated in MBC patients, treated between 01/2001 and 07/2012 at Tuebingen University Hospital, Germany, by immunocytochemistry and cytomorphology. Progression free survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate analysis.

Results: DTC were detected in 64 of 178 (36%) patients. Presence of DTCs was not associated with metastases of the skeletal system (p = 0.816) but more frequent in patients with visceral metastases (p = 0.028). The detection of DTC was a significant predictor of poor OS (median OS of DTC-negative vs. DTC-positive MBC patients: 52 [95% CI: 38 – 67] months versus 28 [95% CI: 19 – 37] months, p = 0,001) but not of poor PFS (p = 0,705). On multivariate analysis, predictors for reduced OS/PFS were PR-status, HER2-status and DTC-status/Grading, HER2-status and line of therapy.

Conclusion: DTC detection in MBC patients is associated with worse outcome. In addition, the detection of DTCs is not related to the presence of bone metastases, but rather associated with the presence of visceral metastases. Accordingly, the bone marrow might represent only a temporary compartment of hematogenous cancer spread and the detection of DTCs is an indicator of aggressive disease.