Funke I, Schraut W
Department of Surgery, University of Munich, Germany.
J Clin Oncol. 1998 Feb;16(2):557-66. doi: 10.1200/JCO.1998.16.2.557.
In 1997, the immunocytologic detection of isolated tumor cells in bone marrow, termed micrometastasis, will be optionally included in the tumor-node-metastasis (TNM) classification indicated M1(i). In the present meta-analyses, 20 studies, which included 2,494 patients, regarding the prognostic influence of a positive bone marrow micrometastases (BMM) status on relapse-free and/or overall survival were analyzed.
The literature search included the Medline and Current Contents bibliographic data bases from August 1980 to June 1997. The statistical evaluation considered the prognostic influence of the prevalence of micrometastatic cells in bone marrow on relapse-free and/or overall survival. The comparable effect estimate and its corresponding 95% confidence interval (CI) were calculated with the Mantel-Haenszel method using the originally published data of the retrieved studies.
The presence of epithelial cells in bone marrow was detectable in all carcinoma types, with a median prevalence of approximately 35%. Fourteen of 20 studies found a positive correlation between positive BMM status and reduced relapse-free survival by univariate analysis, but only five of 11 studies confirmed positive BMM status as an independent predictor of short disease-free survival. Regarding overall survival, positive BMM status was identified univariately in five of 12 studies, but multivariately in only two studies, as an independent factor of poor survival. Despite the heterogeneity of the studies, calculation of the relative risk (RR) for reduced relapse-free survival was possible for breast cancer, which resulted in a Mantel-Haenszel RR (RR(MH)) of 1.34 (95% CI, 1.27 to 1.42).
In conclusion, the results suggest that the prognostic impact of epithelial cells in bone marrow remains to be substantiated by further studies using standardized methodic protocols before its entrance in the TNM classification.
1997年，骨髓中孤立肿瘤细胞的免疫细胞检测，即微转移，将被选择性纳入肿瘤-淋巴结-转移（TNM）分类中，标记为M1(i)。在本次荟萃分析中，分析了20项研究（涉及2494例患者），这些研究探讨了骨髓微转移（BMM）阳性状态对无复发生存率和/或总生存率的预后影响。
文献检索涵盖了1980年8月至1997年6月的Medline和《现刊目次》书目数据库。统计评估考虑了骨髓中微转移细胞的患病率对无复发生存率和/或总生存率的预后影响。使用检索到的研究的原始发表数据，通过Mantel-Haenszel方法计算可比效应估计值及其相应的95%置信区间（CI）。
在所有癌症类型中均能检测到骨髓中的上皮细胞，中位患病率约为35%。20项研究中的14项通过单因素分析发现BMM阳性状态与无复发生存率降低呈正相关，但11项研究中只有5项证实BMM阳性状态是无病生存期短的独立预测因素。关于总生存率，12项研究中的5项通过单因素分析确定BMM阳性状态是不良生存的独立因素，但多因素分析中只有2项研究如此。尽管研究存在异质性，但对于乳腺癌仍可计算无复发生存率降低的相对风险（RR），得出Mantel-Haenszel RR（RR(MH)）为1.34（95%CI，1.27至1.42）。
总之，结果表明，在将骨髓中的上皮细胞纳入TNM分类之前，其预后影响仍有待通过使用标准化方法方案的进一步研究来证实。
