TUMOR-CELL DETECTION IN THE BONE-MARROW OF BREAST-CANCER PATIENTS AT PRIMARY THERAPY - RESULTS OF A 3-YEAR MEDIAN FOLLOW-UP

We examined bone marrow aspirates from 100 metastasis-free primary bre ast cancer patients. In 38/100 patients (38%), tumour cells were detec ted in the marrow using an immunocytochemical technique with a cocktai l of two monoclonal antibodies: anti-EMA and anti-cytokeratin. Median follow-up was 34 months: 15/38 (39%) tumour cell-positive patients hav e since relapsed, but only 9/62 (15%) tumour cell-negative patients. T he median interval between tumour cell detection and relapse was 11.4 months. No statistically significant correlation existed between tumou r cell presence and 'established' prognostic factors. However, relapse -free survival was significantly shorter in tumour cell-positive patie nts. Multivariate analysis showed tumour cell presence as a strong, si gnificant prognostic factor for relapse-free as well as overall surviv al. We conclude that screening for tumour cells in bone marrow of prim ary breast cancer patients identifies high-risk patients for early rel apse. In particular, patients with node-negative tumours who have tumo ur cells in their bone marrow may require subsequent systemic therapy.