Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1865–1871

Prognostic Value of Disseminated Tumor Cells in the Bone Marrow of Patients with Operable Primary Breast Cancer: A Long-term Follow-up Study


  • Christoph Domschke
    • Breast UnitUniversity of Heidelberg
  • Ingo J. Diel
    • CGG-Clinic Mannheim
  • Stefan Englert
    • Institute of Medical Biometry and Informatics, University of Heidelberg
  • Silvia Kalteisen
    • Breast UnitUniversity of Heidelberg
  • Luisa Mayer
    • Breast UnitUniversity of Heidelberg
  • Joachim Rom
    • Breast UnitUniversity of Heidelberg
  • Joerg Heil
    • Breast UnitUniversity of Heidelberg
  • Christof Sohn
    • Breast UnitUniversity of Heidelberg
    • Breast UnitUniversity of Heidelberg
Breast Oncology

DOI: 10.1245/s10434-012-2814-4

Cite this article as:
Domschke, C., Diel, I.J., Englert, S. et al. Ann Surg Oncol (2013) 20: 1865. doi:10.1245/s10434-012-2814-4



Detection of disseminated tumor cells (DTC) in primary breast cancer (BC) patients’ bone marrow (BM) seems to be a surrogate marker of tumor spread and an independent prognostic factor for disease-free and overall survival.


Here we present the largest single-center cohort of patients (n = 1378) with the longest observation time (median 82.0 months). Immunocytochemical staining was performed using murine monoclonal antibody 2E11 with the avidin–biotin complex technique.


At primary surgery, 49 % of patients showed MUC-1 positive cells inside their BM. Patients without BM DTC had significantly more often T1-tumors (P = 0.007) with less often affected axillary lymph nodes (P < 0.001). We observed a significantly higher incidence of distant metastases in DTC positive patients (P < 0.001). This leads to a reduced disease-free survival (P < 0.0001). Furthermore, in DTC positive patients there was a higher mortality rate and, accordingly, a reduced overall survival (P < 0.0001).


Due to the presence of BM DTC, patients with a clinically poorer outcome can be identified at primary surgery. We therefore suggest that DTC analysis can be used as a prognostic factor and monitoring tool in clinical trials. Future study concepts relating to DTC should aim at identification of BC patients who may profit from adjuvant systemic therapy.

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© Society of Surgical Oncology 2012