Disseminated tumor cells predict survival after neoadjuvant therapy in primary breast cancer
Disseminated tumor cells predict survival after neoadjuvant therapy in primary breast cancer
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DOI：
10.1002/cncr.26202
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发表时间：
2012-01-15
期刊：
影响因子：
6.2
通讯作者：
Lucci, Anthony
中科院分区：
文献类型：
--
作者：
Hall, Carolyn;Krishnamurthy, Savitri;Lucci, Anthony
背景：在I-II期乳腺癌(BC)患者中，有30%的患者发现了向骨髓扩散的肿瘤细胞(播散性肿瘤细胞[DTC])，并预测了预后。新辅助化疗(NACT)在缩小原发肿瘤大小或根治术前淋巴结转移方面是有效的，但对NACT后DCs的存在或意义知之甚少。方法：对95例临床分期为I~IIIBC的患者进行DTCS检查。骨髓样本是在完成NACT后采集的，当时他们接受了原发性BC的手术。用抗细胞角蛋白抗体鸡尾酒对DCs进行评估。比较主要肿瘤标志物、淋巴结(LN)受累程度、应用NACT的类型以及对NACT的反应。统计分析采用卡方检验和Fisher精确检验。结果：患者确诊时的中位年龄为51岁，中位随访时间为24个月。46%的患者肿瘤分类为T1/T2，20%的患者为T3肿瘤，34.5%的患者为T4肿瘤，81%的患者在NAT前有淋巴结转移。在NACT后，26%的患者发现了DTC。未观察到DTC与原发肿瘤特征或LN受累之间的关系。有25名患者(26%)病理完全缓解，但不能预测NACT后的DTCs(P=.83)。NACT治疗后的DTC预测BC特异性生存期较差(P
BACKGROUND: Tumor cells that disseminate to the bone marrow (disseminated tumor cells [DTCs]) have been identified in 30% of patients with stage I through II breast cancer (BC) and predict outcome. Neoadjuvant chemotherapy (NACT) is effective in reducing the size of primary tumors or eradicating lymph node metastases before surgery, but little is known regarding the presence or significance of DTCs after NACT. METHODS: The authors evaluated DTCs in 95 patients with clinical stage I through III BC. Bone marrow samples were collected after completion of NACT at the time they underwent surgery for primary BC. DTCs were assessed using an anticytokeratin antibody cocktail. Primary tumor markers, the extent of lymph node (LN) involvement, they type of NACT administered, and response to NACT were compared with presence of DTCs. Chi-square and Fisher exact tests were used for statistical analyses. RESULTS: The median patient age at diagnosis was 51 years, and the median follow-up was 24 months. Forty-six percent of patients had tumors classified as T1/T2, 20% had T3 tumors, 34.5% had T4 tumors, and 81% had lymph node metastasis before NACT. DTCs were identified in 26% of patients after NACT. No associations were observed between DTCs and primary tumor characteristics or LN involvement. A pathologic complete response was observed in 25 patients (26%) but was not predictive of DTCs after NACT (P=.83). DTCs after NACT predicted worse BC-specific survival (P