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Detection of disseminated tumor cells in locally advanced breast cancer patients before primary systemic therapy |
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| Authors: | Montserrat Solá Mireia Margelí Eva Castellá Beatriz Cirauqui Antonio Mariscal Miquel Rull Juan F Julian Miquel Luna Virginia Vallejo Manuel Fraile |
| Institution: | 1. Nuclear Medicine Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;2. Oncology Department, Catalan Institute of Oncology, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;3. Pathology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;4. Radiology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;5. Surgery Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;6. Gynecology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;1. Breast Unit, University of Heidelberg Women''s Hospital, Voßstraße 9, 69115 Heidelberg, Germany;2. Department of Pathology, University of Heidelberg, Heidelberg, Germany;3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;1. Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;2. Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;1. The Breast Care Centre, Southmead Hospital, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK;2. Department of Histopathology, Southmead Hospital, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK |
| Abstract: | AimTo assess the prevalence and prognostic power of disseminated tumor cells (DTC) in patients with locally advanced breast cancer (LABC) before primary systemic therapy (PST).Materials and methodsLABC patients attending our Breast Unit were studied between 2002 and 2012, all of them being considered for PST. To determine the presence of DTC, posterior iliac crest aspirates were obtained and marrow samples were processed by gradient separation with Ficoll (Lymphoprep®) and immunohistochemical staining using the antiCK A45-B/B3 (EPIMET) antibody. Clinicopathologic variables were recorded before and after PST to assess response. Disease-free survival (DFS) and overall survival (OS) were determined after follow-up. The presence of DTC as a predictor of response to PST and as a prognostic tool for OS and DSF was evaluated.ResultsDTC were observed in 26% of 47 patients included in the study. PST consisted of chemotherapy in 94% and hormone therapy in 6%. Breast-conserving therapy was attained in 33%. Mean follow-up was 68 months. Complete clinical response (CR) after PST was seen in 26%, disease recurrence in 38%, and cancer-related death in 8%; tumor size and negative estrogen receptors were significant predictors of CR and mastectomy was associated with DFS. Persistent axillary disease after PST and previous recurrence were predictive of OS. DTC were detected more often in patients who did not achieve CR and those who presented recurrence. DTC detection was a significant prognostic factor for a worse OS (OR = 7.62; CI95%: 1.46–39.61; p = 0.009) and a decreased survival time (62 versus 82 months, p = 0.004).ConclusionPresence of DTC before PST was found in a significant number of patients with LABC. DTC were found to be a significant prognostic factor for cancer-related death. DTC could be a surrogate predictor of response to PST and also of disease recurrence in LABC patients. |
| Keywords: | Locally advanced breast cancer Primary systemic therapy Neoadjuvant chemotherapy Disseminated tumor cells Bone marrow CR"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"complete clinical response CTC"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"circulating tumor cells DCIS"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"ductal carcinoma in situ DFS"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"disease-free survival DTC"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"disseminated tumor cells ISHAGE"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"International Society of Hematotherapy and Graft Engineering LABC"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"locally advanced breast cancer OR"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"odds ratio OS"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"overall survival PST"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"primary systemic treatment RR"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"relative risk |
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