Molino A, Pelosi G, Micciolo R, Turazza M, Nortilli R, Pavanel F, Cetto G L
Department of Medical Oncology, University of Verona, Italy.
Breast Cancer Res Treat. 1999 Nov;58(2):123-30. doi: 10.1023/a:1006336100142.
The presence of epithelial cells in bone marrow may be a prognostic factor in breast cancer, and so we evaluated their evolution in treated and untreated patients. A first bone marrow aspirate was obtained from 125 stage I/II breast cancer patients at diagnosis and repeated every 6-8 months; the samples were processed for leukocyte separation, used to prepare cytospin slides, stained with a pool of monoclonal antibodies (MoAb) recognising epithelial antigens, and immunocytochemically processed. The median follow-up was 48 months (range 15-82); 23 patients relapsed, and 14 died. MoAb positive cells were observed in 31.2% of first, 24.3% of second, and 27.8% of third aspirates. In 68/100 pairs of successive aspirates, bone marrow status remained unchanged; in 20 it became negative, and in 12 positive (not statistically significant even after adjusting for adjuvant therapy). An analysis based on Mantel and Byar's approach to time-dependent covariates using all 225 aspirates found no statistically significant prognostic difference between the patients with negative and positive bone marrow. Bone marrow status changed over time in about 1/3 of the patients; adjuvant therapy did not affect the probability of its becoming negative or positive. No significant association was found between bone marrow evolution and relapse or death, but the relatively high probability of a change in status over time cannot exclude the possibility that a positive aspirate during the course of breast cancer may be a negative prognostic factor.
骨髓中上皮细胞的存在可能是乳腺癌的一个预后因素，因此我们评估了其在接受治疗和未接受治疗的患者中的变化情况。对125例I/II期乳腺癌患者在诊断时进行首次骨髓穿刺，并每6 - 8个月重复一次；样本用于白细胞分离，制备细胞涂片，用一组识别上皮抗原的单克隆抗体（MoAb）染色，并进行免疫细胞化学处理。中位随访时间为48个月（范围15 - 82个月）；23例患者复发，14例死亡。在首次穿刺样本中，31.2%观察到MoAb阳性细胞，第二次为24.3%，第三次为27.8%。在100对连续穿刺样本中，68对骨髓状态保持不变；20对变为阴性，12对变为阳性（即使在调整辅助治疗后也无统计学意义）。使用所有225次穿刺样本，基于Mantel和Byar方法对时间依赖性协变量进行分析，发现骨髓阴性和阳性患者之间无统计学意义的预后差异。约1/3的患者骨髓状态随时间发生变化；辅助治疗不影响其变为阴性或阳性的概率。未发现骨髓变化与复发或死亡之间存在显著关联，但随着时间推移状态变化的相对高概率不能排除乳腺癌病程中穿刺阳性可能是阴性预后因素的可能性。
