Beenmergpunctie: Losse kankercellen in beenmerg voorspellen de recidiefkansen voor vrouwen met borstkanker met aangetaste lymfklieren ongeacht welke behandeling dan ook.

27 juni 2010: Lees ook artikel: Operatie: Routinematige operatie van de okselklieren bij beginnende borstkanker is onnodig en beinvloed kwaliteit van leven onnodig als er verder geen aantoonbare uitzaaiingen zijn en schildwachtklier schoon is

d.d. 15 oktober 2003: Bron: The Journal of Clinical Oncology Sep 15 2003: 3469-3478)

Losse kankercellen in beenmerg voorspellen de recidiefkansen voor vrouwen met borstkanker met aangetaste lymfklieren ongeacht welke behandeling dan ook.

De aanwezigheid van geïsoleerde kankercellen in het beenmerg bij borstkanker geeft waarschijnlijk voorspellende informatie (30,6% kans op recidief voor vrouwen met wel losse kankercellen in het beenmerg t/o 13,3 % met vrouwen zonder losse kankercellen in beenmerg) of er later wel of geen recidief zal optreden ongeacht welke behandeling (chemo, operatie, bestraling, hormoontherapie) dan ook bij beginnende borstkanker, zo zijn de conclusies uit een eerste onderzoek bij 800 vrouwen in verschillende medische centra in Noorwegen (gepubliceerd in The Journal of Clinical Oncology Sep 15 2003: 3469-3478). Opvallend is dat vrouwen waarbij een of meer lymfklieren zijn aangetast op het moment van behandelen met chemo, operatie en/of bestraling de aanwezigheid van losse kankercellen in het beenmerg een significant verschil in voorspelling voor een recidief gaven 51,8 % tegenover 25%. Daarin tegenover: vrouwen met borstkanker waarbij de lymfklieren ten tijde van de behandeling met operatie, chemo en/of bestraling niet zijn aangetast gaf geen voorspellend verschil op een recidief te zien 8% tegenover 8%. De onderzoekers pleiten dan ook voor een beenmergpunctie vooraf aan een behandelingsplan en op grond van uitslag de individuele behandeling aan te passen. Uiteraard wordt gesteld dat er nog meer onderzoek nodig is. Hieronder het Engelstalige abstract en persbericht van de Noorse studie.

Presence of Tumor Cells in Bone Marrow May Predict Relapse in Early-stage Breast Cancer
10/10/2003

A significant proportion of women with early-stage breast cancer will have a recurrence of their tumor, even after receiving the best surgical and medical treatment. The presence of tumor in the local lymph nodes (or “axillary nodes”) has been identified as the best available way to identify those women who are more likely to have a recurrence. In women with axillary lymph node involvement (also called “LN-positive”), more than 50% will go on to have cancer relapse.

At present, we do not have a reliable means of determining which women in these groups are at higher or lower risk of relapse. A better indicator of the likelihood of cancer relapse is greatly needed, to allow a more individualized approach to the treatment of early-stage breast cancer.

A recent study suggests that the presence of isolated tumor cells in the bone marrow may independently predict the likelihood of tumor recurrence, and when combined with other clinical factors, can be used to classify early stage breast cancer patients into high-risk and low-risk groups.

In this study, performed by Dr. Gro Wiedswang and colleagues at several medical centers in Oslo, Norway, bone marrow specimens were collected from more than 800 women with early-stage breast cancer before their initial surgery. These women subsequently received standard therapy for their cancer, including surgery, radiation therapy, hormonal therapy and/or chemotherapy. They were then studied for about 4 years. The bone marrow biopsy specimens were processed in the lab to identify any breast cancer cells among the normal bone marrow cells. Samples that clearly had cancer cells were labeled as having isolated tumor cells in the bone marrow, or “ITC+”. Cancer relapse was more common in women who were ITC+ than in those with no evidence of tumor cells in the bone marrow—30.6% vs. 13.3%. Statistical analysis demonstrated that the presence of ITC in the bone marrow was an independent marker of distant tumor recurrence in these women. Interestingly, the presence of cancer cells in the bone marrow had no effect on the chance of tumor recurrence in women who were LN-negative (8% vs 8%), but had a marked effect in women who were LN-positive (51.8 % vs. 25.5% recurrence). The incidence of recurrence in LN-negative women was low in this study, and longer follow-up data may be required to determine definitively if the presence of ITC in bone marrow is an independent prognostic factor in LN-negative breast cancer.

When the presence of ITC in bone marrow was combined with other factors, such as tumor size and the presence of the estrogen receptor (ER), the authors were able to classify LN-positive tumors into high-risk and low-risk groups. The low risk group—no cancer cells in the bone marrow, ER+, and a tumor size less than 2 cm—had a low risk of relapse (3%). The high-risk group had a much higher relapse rate (37.3%). The authors suggest that the use of bone marrow biopsy to look for ITC may, in combination with other factors, better identify the risk of tumor relapse in women with early-stage breast cancer.

Reference:

G. Wiedswang, E. Borgen, R. Kåresen, G. Kvalheim, J.M. Nesland, H. Qvist, E. Schlichting, T. Sauer, J. Janbu, T. Harbitz, and B. Naume. Detection of Isolated Tumor Cells in Bone Marrow Is an Independent Prognostic Factor in Breast Cancer. Journal of Clinical Oncology Sep 15 2003: 3469-3478.