Prognostic indicators of metastatic bone disease in human breast cancer

Abstract

The time to detection of metastatic bone disease (MBD) by radiographic examination was studied in 221 patients with advanced breast cancer. None of the patients had bone metastases by radiography or bone marrow carcinosis, evaluated by bilateral iliac crest biopsy. The period of follow‐up after first recurrence was 46 months. Fifty‐five patients (25%) had MBD; 89 patients died without MBD. The cumulated rate of MBD was 14% and 27% after 1 and 2 years, respectively. The actuarial time to MBD was associated significantly with the presence of positive regional lymph nodes at primary diagnosis, the occurrence of metastases in the mediastinum, and the presence of visceral metastases. Moreover, a positive bone scintigraphic scan at the time of first recurrence and abnormal biochemical analyses from serum also were associated significantly with a shortened time to MBD. Micrometastases in the bone marrow, as detected by monoclonal antibodies against epithelial markers (epithelial membrane antigen and cytokeratin), were present in 18% of the patients. The presence of such tumor cells was not associated with development of radiologic MBD. Cox analyses revealed that the result of bone scintigraphic scanning and the presence of visceral metastases were the most important and independent predictors of the time to MBD. Four distinct prognostic groups were identified based on the status of these two variables. The recognition of these prognostic groups has several implications for clinical and therapeutic management of patients with recurrent breast cancer.

The prognosis of skeletal metastases

“…Etwa 30 % aller Patienten mit lokalisiertem Tumor zeigen immunhistochemisch ossäre Mikrometastasen, allerdings ohne sichere prognostische Signifikanz [9]. B. beim Tumorrezidiv, ist zu 50 % mit ossären Filiae zu rechnen, bei am Mammakarzinom verstorbenen Patientinnen in etwa 80 % [10]. B. beim Tumorrezidiv, ist zu 50 % mit ossären Filiae zu rechnen, bei am Mammakarzinom verstorbenen Patientinnen in etwa 80 % [10].…”

Detection of metastases in sentinel lymph nodes of breast cancer patients by multiple mRNA markers

“…Involvement of lymph nodes and the number of lymph nodes harbouring metastases at primary diagnosis have an inverse relationship with the disease prognosis, meaning that patients with lymph nodes free of metastases have a better outcome (Fisher et al, 1983;Carter et al, 1989;Hellman, 1994;Quiet et al, 1995;Saimura et al, 1999). However, 20 -30% of node-negative patients will develop a relapse in 5 -10 years after diagnosis (Kamby et al, 1991;Hellman, 1994). In addition, it is known that 20 -30% of node-positive patients are long-term survivors (Rosen et al, 1989;Joensuu et al, 1998).…”

Systemic immunotoxin treatment inhibits formation of human breast cancer metastasis and tumor growth in nude rats

“…Notably, the results demonstrate that this targeted therapy enabled effective eradication of micrometastatic MT-1 cells lodged in bone marrow and other major organs, as histopathological examination of treatment failures did not detect relapse in these tissues. That the presence of tumor cells in the bone marrow seem to indicate early relapse and poor prognosis in breast cancer patients (Cote et al, 1991;Diel et al, 1992;Harbeck et al, 1994;Kamby et al, 1991) makes treatment with ITs an interesting alternative as a feasible approach for adjuvant antimetastatic treatment.…”