Here it is: Circulating tumor cells associated with bad px in EARLY breast cancer

[Lani]

previous articles were only with metastatic breast cancer

Will have to see if the CELLSEARCH test I referred to in my previous post is the same technology as used in this article to find CTCs

This certain seems like an improvement to--wait until you have bone pain from fracture or a headache before we look to see if it is coming/has come back!


10 August 2006
Circulating tumor cells predict poor node-negative prognosis
Circulating tumor cells (CTCs) may be used to identify patients with node-negative (N0) breast cancer who are at high risk of a poor outcome, say Greek researchers who believe the prognostic factor could be used to guide treatment decisions.

Previously, they showed that the presence of peripheral blood CTCs positive for cytokeratin (CK)-19 mRNA is an independent prognostic factor for recurrent disease and poor survival in patients with stage I and II operable breast cancer.

To investigate further, the team used a real-time polymerase chain reaction assay to assess for CK-19 mRNA-positive cells in blood samples from 167 N0 breast cancer patients who had undergone surgery but were chemotherapy-naïve. The participants were followed-up for a median of 32 months, during which time they received a range of adjuvant systemic therapies.

In all, 21.6% of patients were positive for the CTCs, Vassilis Georgoulias (University General Hospital of Heraklion, Crete) and colleagues report.

Interestingly, the researchers found that patients with CTCs were significantly more likely to be positive for human epidermal growth factor 2 (HER2/neu) expression than those without the cells (36.1% vs 19.1%).

No significant correlation was detected between CK-19 mRNA-positive cells and other patient or tumor characteristics such as age, menopausal status, histology, size, and hormone receptor status.

However, multivariate analysis indicated that CK-19 mRNA-positivity predicted both early clinical relapse and breast cancer-related mortality in the women.

In particular, CTCs predicted reduced disease-free survival (hazard ratio [HR]=26.32), along with estrogen receptor-negative status (HR=5.54), grade III disease (HR=3.79), and premenopausal status (HR=4.64). Overall survival was predicted by CK19 mRNA-positivity alone, with a HR of 17.94.

Writing in the Journal of Clinical Oncology, the team says that the development of techniques to measure disseminated tumor cells in blood rather than bone marrow "opens the way to further investigate important questions such as whether the detection of CTCs should be performed in all patients at the time of primary diagnosis to identify high-risk patients, or whether CTCs detection at diagnosis should modify the adjuvant therapeutic strategy, or finally, whether the detection of CTCs during the administration of adjuvant treatment would allow the development of secondary adjuvant theapeutic strategies."

The authors conclude: "The study and evaluation of the clinical relevance of CTCs opens the possibility of early and tailored treatment interventions for patients with persisting occult tumor cells after systemic adjuvant treatment."



J Clin Oncol 2006; 24: 3756–3762

http://www.jco.org/cgi/content/abstract/24/23/3756