Abstract
OBJECTIVE:
Detection
of disseminated tumor cells (DTCs) in the bone marrow (BM) of patients
with breast cancer is associated with poor outcomes. Recent studies
demonstrated that DTCs may serve as a prognostic factor in ovarian
cancer. The aim of this 3-center study was to evaluate the impact of BM
status on survival in a large cohort of patients with ovarian cancer.
MATERIALS AND METHODS:
Four
hundred ninety-five patients with primary ovarian cancer were included
in this 3-center prospective study. Bone marrow aspirates were collected
intraoperatively from the iliac crest. Disseminated tumor cells were
identified by antibody staining and by cytomorphology. Clinical outcome
was correlated with the presence of DTCs.
RESULTS:
Disseminated
tumor cells were detected in 27% of all BM aspirates. The number of
cytokeratin-positive cells ranged from 1 to 42 per 2 × 10 mononuclear
cells. Disseminated tumor cell status did correlate with histologic
subtype but not with any of the other established clinicopathologic
factors. The overall survival was significantly shorter among
DTC-positive patients compared to DTC-negative patients (51 months; 95%
confidence interval, 37-65 months vs 33 months; 95% confidence interval,
23-43 months; P = 0.023). In the multivariate analysis, BM status,
International Federation of Gynecology and Obstetrics stage, nodal
status, resection status, and age were independent predictors of reduced
overall survival, whereas only BM status, International Federation of
Gynecology and Obstetrics stage, and resection status independently
predicted progression-free survival.
CONCLUSIONS:
Tumor
cell dissemination into the BM is a common phenomenon in ovarian cancer.
Disseminated tumor cell detection has the potential to become an
important biomarker for prognostication and disease monitoring in
patients with ovarian cancer.
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