Journal of Clinical Oncology, Vol 10, 1534-1539, Copyright © 1992 by American Society of Clinical Oncology
Detection of tumor cells in bone marrow of patients with primary breast cancer: a prognostic factor for distant metastasis
IJ Diel, M Kaufmann, R Goerner, SD Costa, S Kaul and G Bastert
Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany.
PURPOSE: At the time of primary surgery, approximately 90% of all patients
with breast cancer are free of metastases, but in the next 5 years almost
50% of them will relapse. We evaluated the significance of the presence of
tumor cells in bone marrow of patients with primary breast cancer to
investigate their predictive value for relapse. PATIENTS AND METHODS: Two
hundred sixty patients with primary breast cancer were examined for tumor
cells in bone marrow aspirates taken from six sites of the skeleton. After
density centrifugation, cells in interphase were smeared and stained. For
the immunocytologic reaction, we used a new monoclonal antibody (2E11) that
was reactive with the core protein of the tumor-associated glycoprotein
TAG12. TAG12 is secreted by nearly all human breast carcinomas. RESULTS: A
significant correlation was found between tumor-cell detection and tumor
stage (P < .0001), nodal status (P < .0001), and tumor grading (P =
.002). A good relation to progesterone receptor (PR; P = .008) was found,
but there was no correlation to estrogen receptor (ER) and menopausal
status. Follow-up examinations showed distant metastases in 26 of 211
patients (15%). Twenty-two relapses occurred among the 81 patients with
2E11- positive cells in bone marrow, but only four occurred among the 130
patients without tumor-cell detection. CONCLUSIONS: This study suggests
that tumor-cell detection in bone marrow of patients with primary breast
carcinoma is a good predictor for all distant relapses (P < .0005, Cox
multiple regression analysis) and provides additional information in regard
to other prognostic factors. The highest predicting value for distant
metastasis results from the combination of nodal status, negative PR, and
tumor-cell presence in bone marrow.
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