Micrometastatic Breast Cancer Cells in Bone Marrow at Primary Surgery: Prognostic Value in Comparison With Nodal Status

Background: Approximately 30% of the patients with primary breast cancer who have no axillary lymph node involvement (i.e., lymph node negative) at the time of surgery will relapse within 10 years; 10%–20% of the patients with distant metastases will be lymph node negative at surgery. Axillary lymph...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 1996-11, Vol.88 (22), p.1652-1658
Main Authors: Diel, Ingo J., Kaufmann, Manfred, Costa, Serban D., Holle, Rolf, von Minckwitz, Gunter, Solomayer, Erich F., Kaul, Sepp, Bastert, Gunther
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Axilla
Biological and medical sciences
Bone marrow
Bone Marrow Neoplasms - diagnosis
Bone Marrow Neoplasms - secondary
Breast cancer
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Cells
Chi-Square Distribution
Female
Gynecology. Andrology. Obstetrics
Humans
Ilium
Immunohistochemistry
Lymph Node Excision
Lymphatic Metastasis
Mammary gland diseases
Medical sciences
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Surgery
Survival Analysis
Tumors
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Summary:Background: Approximately 30% of the patients with primary breast cancer who have no axillary lymph node involvement (i.e., lymph node negative) at the time of surgery will relapse within 10 years; 10%–20% of the patients with distant metastases will be lymph node negative at surgery. Axillary lymph node dissection, as a surgical procedure, is associated with frequent complications. A possible alternative to nodal dissection in terms of prognosis may be the immunocytochemical detection of tumor cells in bone marrow. Purpose: In a prospective study, the value of tumor cell detection (TCD) in bone marrow was compared with axillary lymph node dissection in the prognosis of primary breast cancer after surgery. Methods: Data from 727 patients with primary, operable breast cancer were included in the analysis. All patients had surgery, including axillary lymph node dissection, from May 1985 through July 1994 at the Women's Hospital of the University of Heidelberg (Federal Republic of Germany). Bone marrow aspiration at two sites on each anterior iliac crest was performed immediately after surgery while the patients were under general anesthesia. Most patients received some type of systemic adjuvant therapy. The monoclonal antibody 2E11, directed against the polymorphic epithelial mucin TAG12, was used to detect tumor cells in bone marrow samples. The association of TCD with recognized prognostic indicators was evaluated by means of chi-squared tests. Survival without the development of distant metastases (i.e., distant disease-free survival) and overall survival were estimated by use of the Kaplan-Meier method; the logrank test was used to compare survival curves. A multivariate Cox regression analysis with stratification according to adjuvant treatment type was used to assess the independent prognostic value of TCD in bone marrow in relation to other variables. Reported P values are two-sided. Results: Tumor cells were detected in the bone marrow of 203 (55%) of 367 lymph node-positive patients and in 112 (31%) of 360 lymph node-negative patients. TCD was associated with larger tumors (P
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/88.22.1652