Konsensusempfehlungen zu methodischen Aspekten und zur klinischen Relevanz des Nachweises disseminierter Tumorzellen (DTZ) im Knochenmark (KM) von Patientinnen mit primärem Mammakarzinom

T. Fehm; V. Müller; W. Janni; S. Braun; G. Gebauer; C. Marth; C. Schindlbeck; D. Wallwiener; E. Borgen; K. Pantel; E. Solomayer

doi:10.1055/s-2006-955919

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Geburtshilfe Frauenheilkd 2007; 67(4): 329-335
DOI: 10.1055/s-2006-955919

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Konsensusempfehlungen zu methodischen Aspekten und zur klinischen Relevanz des Nachweises disseminierter Tumorzellen (DTZ) im Knochenmark (KM) von Patientinnen mit primärem Mammakarzinom

Ergebnisse des Konsensustreffens im Rahmen der Dreiländertagung Senologie, Stuttgart, September 2005Consensus Recommendations on Methodical Aspects and Clinical Relevance of the Evidence of Disseminated Tumor Cells in the Bone Marrow of Patients with Primary Breast CancerT. Fehm¹ ^, ⁸ , V. Müller² ^, ⁸ , W. Janni³ ^, ⁸ , S. Braun⁴ ^, ⁸ , G. Gebauer⁵ ^, ⁸ , C. Marth⁴ ^, ⁸ , C. Schindlbeck³ ^, ⁸ , D. Wallwiener¹ ^, ⁸ , E. Borgen⁶ ^, ⁹ , K. Pantel⁷ ^, ⁸ ^, ⁹ , E. Solomayer¹ ^, ⁸

¹Universitätsfrauenklinik Tübingen, Calwer Straße 7, 72076 Tübingen
²Universitätsfrauenklinik Hamburg, Martinistraße 52, 20246 Hamburg
³Universitätsfrauenklinik LMU, Maistraße 11, 80337 München
⁴Universitätsfrauenklinik Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
⁵Universitätsfrauenklinik Heidelberg, Vossstraße 9, 69115 Heidelberg
⁶Institut für Pathologie, Radium Hospital, Ullernchausseen 70, 0310 Oslo, Norwegen
⁷Institut für Tumorbiologie, Martinistraße52, 20246 Hamburg
⁸stellvertetend für die Kommission Tumorzelldissemination der Senologie
⁹stellvertretend für DISMAL (Disseminated Malignancies) Projekt Konsortium (unterstützt durch das European Community's Framework programme, LSHC‐CT-2005-018911)

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Publication History

eingereicht 22.6.2006 revidiert 30.9.2006

akzeptiert 12.10.2006

Publication Date:
08 May 2007 (online)

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Zusammenfassung

Das Gebiet der Tumorzelldissemination beim Mammakarzinom hat in den letzten Jahren immer mehr an Bedeutung gewonnen. Durch den Nachweis disseminierter Tumorzellen im Knochenmark und Blut wurde bewiesen, dass das Mammakarzinom eine systemische Erkrankung ist. Disseminierte Tumorzellen können bei 20 - 40 % aller Mammakarzinompatientinnen detektiert werden. Die Daten der Pooled Analysis der Collaborative Bone Marrow Micrometastasis Group bestätigten den Tumorzellnachweis im Knochenmark als unabhängigen prognostischen Marker. Darüber hinaus ist die Prognose für Frauen mit Tumorzellpersistenz nach adjuvanter systemischer Therapie im Vergleich zu den Patientinnen ohne Tumorzellnachweis deutlich schlechter. In zukünftigen Studien müssen nun Therapieansätze evaluiert werden, die die Eliminierung disseminierter Tumorzellen zum Ziel haben. Eine entscheidende Voraussetzung für die Durchführung von solchen (Multizenter-)Studien ist, dass ein standardisiertes Vorgehen zum Nachweis von disseminierten Tumorzellen im Knochenmark definiert wird. Im Rahmen der Dreiländertagung der Gesellschaften für Senologie traf sich daher ein internationales Expertenpanel aus Deutschland, der Schweiz und aus Österreich, um die bestehenden Methoden zum Tumorzellnachweis im Knochenmark zu evaluieren sowie einen Konsensus für den standardisierten Nachweis sowie die klinische Implementierung festzulegen.

Abstract

The presence of disseminated tumor cells in blood and bone marrow (BM) has confirmed the hypothesis of breast cancer as a systemic disease. Disseminated tumor cells (DTC) are already present in 20 - 40 % of primary breast cancer patients without clinical evidence of metastatic disease. A large pooled analysis has recently shown that the presence of disseminated tumor cells in the bone marrow (BM) of primary breast cancer patients (stages I - III) is associated with poor prognosis. Moreover, tumor cell persistence after completion of adjuvant therapy identifies patients at a high risk for recurrence. To date, sampling of BM and assessment of DTC is not considered a routine procedure in the clinical management of breast cancer patients, but emerging data suggests a future role for risk stratification and monitoring of therapeutic efficacy. Since these clinical options need to be evaluated in clinical trials, agreement on the standardized detection of DTC is mandatory. Therefore, the German, Austrian and Swiss Societies for Senology recently initiated an international consensus meeting to define a consensus for the standardized detection of DTC and to explore the options for its clinical implementation.

Schlüsselwörter

Mammakarzinom - Tumorzelldissemination - Konsensustreffen - Prognose

Key words

Breast cancer - tumor cell dissemination - consensus meeting - prognosis

Literatur

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PD Dr. Tanja Fehm

Universitätsfrauenklinik Tübingen

Calwer Straße 7

72076 Tübingen

Email: tanja.fehm@t-online.de