gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Persistence of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients predicts increased risk for relapse – results of pooled European data

Meeting Abstract

  • corresponding author presenting/speaker Wolfgang Janni - Universitätsklinikum LMU München, Deutschland
  • Björn Naume - Department of Oncology, Radiumhospitalet, Oslo
  • Brigitte Rack - Universitätsklinikum LMU München
  • Christian Schindlbeck - Universitätsklinikum LMU München
  • Gro Wiedswang - Department of Surgery, Ullevaal University Hospital, Oslo,
  • E. Borgen - Department of Pathology, Radiumhospitalet, Oslo
  • Stephan Braun - Universitaetsklinikum fuer Frauenheilkunde, Leopold-Franzens-Universitaet, Innsbruck
  • Harald Sommer - Universitätsklinikum LMU München
  • Klaus Pantel - Institut für Tumorbiologie, UKE, Hamburg
  • Bernd Gerber - Departments of Obstetrics and Gynecology, University of Rostock
  • J. Nesland - Department of Pathology, Radiumhospitalet, Oslo
  • Klaus Friese - Universitätsklinikum LMU München

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO075

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Janni et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The prognostic significance of DTC in the BM of breast cancer patients at the time of primary diagnosis has recently been confirmed by a large pooled analysis (Figure 1 [Fig. 1]). If the persistence of DTC after adjuvant therapy confers a similar risk for relapse, there might be an indication for secondary adjuvant treatment.

Methods: We analyzed BM aspirates of 584 patients from academic breast cancer units in Oslo (n=356) and Munich (n=228) during recurrence-free follow-up at a median interval of 38.6 months (standard deviation [std] 18.9 mon) after primary diagnosis of breast cancer pT1-4, pN0-3 pM0. Carcinoma cells were detected using a standardized immunoassay with the monoclonal antibodies A45-B/B3 (Munich) or AE1 and AE3 (Oslo), directed against cytokeratin (CK). Patients were followed for a median of 62.7 months (std 23.1 mon) after primary diagnosis.

Results: Persistent DTC in the BM were detected in 14.0% of the patients (n=82). The Kaplan-Meier estimate for mean relapse-free survival was 159.0 mon (153.2 – 164.7 95% CI) in patients with negative and 91.5 mon (74.4 – 108.6, 95% CI, p< .0001, log rank test) in patients with positive BM status. Patients without evidence of persistent DTC had a significantly longer overall survival (165.5 [156.7 – 174.4]), than patients with positive BM status (104.0 mon [91.5 – 116.5], p< .0001). In multivariate Cox regression analysis, allowing for bone marrow status, tumor size and nodal status, DTC was an independent significant predictor for reduced breast cancer specific survival (RR 5.1, p< .0001).

Conclusion: Evidence of persistent DTC in breast cancer patients indicates an increased risk for subsequent relapse, and may serve for monitoring in future clinical trials. Such trials might investigate the benefit of individualized secondary adjuvant treatment or extended adjuvant therapy of patients with DTC.


Braun S. NEJM. 2005 Aug 25;353(8):793-802.