诊断时的微转移骨髓细胞对接受干细胞支持的大剂量化疗的伴有广泛腋窝淋巴结受累的原发性乳腺癌患者的生存没有影响。

Micrometastatic bone marrow cells at diagnosis have no impact on survival of primary breast cancer patients with extensive axillary lymph node involvement treated with stem cell-supported high-dose chemotherapy.

作者信息

Schneeweiss A, Diel I, Hensel M, Kaul S, Sinn H-P, Unnebrink K, Rudlowski C, Lauschner I, Schuetz F, Egerer G, Haas R, Ho A D, Bastert G

机构信息

University of Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany.

出版信息

Ann Oncol. 2004 Nov;15(11):1627-32. doi: 10.1093/annonc/mdh433.

DOI:10.1093/annonc/mdh433

PMID:15520063

Abstract

BACKGROUND

To determine the impact of micrometastatic bone marrow cells (MMC) on survival in high-risk primary breast cancer (HRPBC) patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT).

PATIENTS AND METHODS

Ninety-one HRPBC patients (73 patients with > or =10 involved axillary lymph nodes (ALN), 18 premenopausal women with > or =4 involved ALN) received one cycle (eight patients) or two cycles of HDCT and ASCT. Bone marrow aspiration was performed before systemic treatment to search for MMC using a cocktail of four monoclonal epithelial-specific antibodies (5D3, HEA125, BM7 and BM8). The influence of MMC and other prognostic factors on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) was analysed.

RESULTS

In 23 of 91 patients (25%) we detected a median of three MMC (range, 1-43) among 10(6) mononuclear cells. With a median follow-up of 62 months (range, 10-117), the detection of MMC was not associated with DFS (P=0.929), DDFS (P=0.664) or OS (P=0.642). In multivariate analysis the strongest predictor was nodal ratio for DFS (P=0.012) and expression of p53 for OS (P <0.001).

CONCLUSION

The detection of MMC at diagnosis has no impact on survival in HRPBC patients treated with HDCT and ASCT.

摘要

背景

确定微转移骨髓细胞（MMC）对接受大剂量化疗（HDCT）和自体干细胞移植（ASCT）治疗的高危原发性乳腺癌（HRPBC）患者生存的影响。

患者与方法

91例HRPBC患者（73例腋窝淋巴结（ALN）受累≥10个，18例绝经前女性ALN受累≥4个）接受了一个周期（8例患者）或两个周期的HDCT和ASCT。在全身治疗前进行骨髓穿刺，使用四种单克隆上皮特异性抗体（5D3、HEA125、BM7和BM8）混合物来寻找MMC。分析MMC和其他预后因素对无病生存期（DFS）、远处无病生存期（DDFS）和总生存期（OS）的影响。

结果

在91例患者中的23例（25%）中，我们在10⁶个单核细胞中检测到MMC的中位数为3个（范围为1 - 43个）。中位随访62个月（范围为10 - 117个月），MMC的检测与DFS（P = 0.929）、DDFS（P = 0.664）或OS（P = 0.642）均无关。在多变量分析中，DFS的最强预测因素是淋巴结比值（P = 0.012），OS的最强预测因素是p53的表达（P < 0.001）。