Disseminated tumor cells from the bone marrow of patients with non-metastatic primary breast cancer are predictive of locoregional relapse
Mené sur 3 072 patientes atteintes d'un cancer primitif non métastatique du sein, cet essai met en évidence une association entre la présence de cellules tumorales dans la moelle osseuse et le risque de récidive locorégionale
Background : Disseminated tumor cells (DTCs) are detectable in the bone marrow (BM) of patients with primary breast cancer (PBC) and predictive of an impaired prognosis. This large trial aimed to analyze the impact of DTC detection on locoregional relapse (LR).
Patients and methods : Patients with non-metastatic PBC were eligible for this analysis. BM aspiration (BMA1) was performed during primary surgery and DTCs were detected by using immunocytochemistry (A45-B/B3 antibody against pancytokeratin) and morphological criteria. At the time of LR, a subgroup of patients with non-metastatic and operable LR received a secondary BM aspiration (BMA2).
Results : 3.072 patients were included into the analysis. Of these 732 (24%) presented with DTCs at BMA1. 139 patients experienced LR and 48 of these (35%) were initially DTC-positive. DTC detection was significantly associated with an increased risk of LR in univariate (P=0.002) and multivariate analysis (P=0.009) with a hazard ratio of 1.65 (95% confidence interval: 1.13-2.40). Of the patients with LR, 55 patients were available for BMA2 and 17 of these (32%) were DTC-positive. DTC detection at the time of LR was indicative of impaired overall survival (univariate analysis, P=0.037).
Conclusions : DTC detection in patients with PBC is associated with an increased risk of LR, indicating that tumor cells may have the ability to recirculate from the BM to the site of the primary tumor. The impaired prognosis associated with DTC detection at the time of LR may help to identify patients that are in need for additional or more aggressive treatment.
Annals of Oncology , résumé, 2015