Clinical trial

Breast Cancer Research and Treatment

, Volume 144, Issue 2, pp 353-360

Disseminated tumor cells as a monitoring tool for adjuvant therapy in patients with primary breast cancer

  • Ines GruberAffiliated withDepartment of Obstetrics and Gynecology, University of Tuebingen Email author 
  • , Tanja FehmAffiliated withDepartment of Obstetrics and Gynecology, University of Heidelberg
  • , Florin Andrei TaranAffiliated withDepartment of Obstetrics and Gynecology, University of Tuebingen
  • , Markus WallwienerAffiliated withDepartment of Obstetrics and Gynecology, University of Duesseldorf
  • , Markus HahnAffiliated withDepartment of Obstetrics and Gynecology, University of Tuebingen
  • , Diethelm WallwienerAffiliated withDepartment of Obstetrics and Gynecology, University of Tuebingen
  • , Natalia KrawzyckAffiliated withDepartment of Obstetrics and Gynecology, University of Heidelberg
  • , Juergen HoffmannAffiliated withDepartment of Obstetrics and Gynecology, University of Heidelberg
  • , Andreas Daniel HartkopfAffiliated withDepartment of Obstetrics and Gynecology, University of Tuebingen

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Abstract

The presence of disseminated tumor cells (DTC) in the bone marrow (BM) of early breast cancer patients at initial surgery as well as during follow-up predicts an unfavorable outcome. This study aimed to assess whether adjuvant systemic therapy has the ability to eradicate DTC and to determine the clinical impact of DTC-persistence. Between 12 and 24 months after an initial BM aspiration during primary surgery (BMA1) a second and third bone marrow aspiration (BMA2 and BMA3, respectively) was performed. DTC were identified by immunocytochemistry (pancytokeratin antibody A45-B/B3) and cytomorphology. A total of 190 patients who were DTC-positive at BMA1 were eligible for this retrospective analysis. DTC persisted in 35 of 190 (19 %) patients at BMA2 and in 11 of 71 (16 %) patients at BMA3. DTC-persistence at BMA3 was significantly lower in patients that received adjuvant endocrine therapy (p = 0.017). At BMA2, DTC-positive patients were at an increased risk of disease recurrence (HR: 4.17, 95 % CI: 1.51–11.50, p = 0.003) and death (HR: 5.02, 95 % CI: 1.156–21.83, p = 0.031). At BMA3, the presence of DTC was associated with shorter disease free survival (HR: 3.20, 95 % CI: 1.05–9.78, p = 0.010). In conclusion, a majority of initially DTC-positive primary breast cancer patients turned negative during adjuvant treatment. As DTC-persistence predicted an adverse outcome, serial DTC-determination can identify patients that will probably benefit from additional or a switch of adjuvant therapy.

Keywords

Disseminated tumot cells Primary breast cancer Adjuvant therapy