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Previous Volume 353:793-802 August 25, 2005 Number 8 Next

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ABSTRACT

Background We assessed the prognostic significance of the presence of micrometastasis in the bone marrow at the time of diagnosis of breast cancer by means of a pooled analysis.

Methods We combined individual patient data from nine studies involving 4703 patients with stage I, II, or III breast cancer. We evaluated patient outcomes over a 10-year follow-up period (median, 5.2 years), using a multivariable piecewise Cox regression model.

Results Micrometastasis was detected in 30.6 percent of the patients. As compared with women without bone marrow micrometastasis, patients with bone marrow micrometastasis had larger tumors and tumors with a higher histologic grade and more often had lymph-node metastases and hormone receptor-negative tumors (P<0.001 for all variables). The presence of micrometastasis was a significant prognostic factor with respect to poor overall survival and breast-cancer–specific survival (univariate mortality ratios, 2.15 and 2.44, respectively; P<0.001 for both outcomes) and poor disease-free survival and distant-disease–free survival during the 10-year observation period (incidence-rate ratios, 2.13 and 2.33, respectively; P<0.001 for both outcomes). In the multivariable analysis, micrometastasis was an independent predictor of a poor outcome. In the univariate subgroup analysis, breast-cancer–specific survival among patients with micrometastasis was significantly shortened (P<0.001 for all comparisons) among those receiving adjuvant endocrine treatment (mortality ratio, 3.22) or cytotoxic therapy (mortality ratio, 2.32) and among patients who had tumors no larger than 2 cm in diameter without lymph-node metastasis and who did not receive systemic adjuvant therapy (mortality ratio, 3.65).

Conclusions The presence of micrometastasis in the bone marrow at the time of diagnosis of breast cancer is associated with a poor prognosis.

Source Information

From the Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria (S.B., C.M.); Department of Obstetrics and Gynecology, General Hospital, Merano, Italy (F.D.V.); Department of Oncology, Norwegian Radium Hospital, Oslo (B.N.); Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany (W.J., B.S.); Department of Surgery, New York Presbyterian Hospital, Cornell University, New York (M.P.O.); Division of Medicine, Imperial College, London (R.C.C.); Department of Hematology and Oncology, Central Hospital, Augsburg, Germany (G.S., D.O.); Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany (I.J.D., E.-F.S.); Department of Obstetrics and Gynecology, University Hospital, Rostock, Germany (B.G., G.K.); Department of Obstetrics and Gynecology, Nuremberg-Erlangen University Hospital, Erlangen, Germany (G.G., T.F.); Department of Hematology and Oncology, Institut Curie, Paris, (J.-Y.P., A.V.-S.); Department of Surgery, Ullevål University Hospital, Oslo (G.W.); Strang Cancer Prevention Center, Cornell Medical Center, New York (G.Y.C.W.); Institute of Cancer Research, Sutton, United Kingdom (J.B.); and Institute of Tumor Biology, Eppendorf University, Hamburg, Germany (K.P.).

Drs. Braun and Vogl contributed equally to this manuscript.

Address reprint requests to Dr. Braun at the Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria, or at stephan.braun{at}uklibk.ac.at

Full Text of this Article

Related Letters:

Bone Marrow Micrometastases in Breast Cancer
Jeruss J. S., Kuerer H. M., Braun S., Vogl F. D.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:2191, Nov 17, 2005. Correspondence

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