scholarly journals Prognostic and Predictive Value of Circulating and Disseminated Tumor Cells in Breast Cancer: A National Cancer Database (NCDB) Analysis

2020 ◽  
Vol 19 ◽  
pp. 153303382098010
Author(s):  
Nadeem Bilani ◽  
Leah Elson ◽  
Hong Liang ◽  
Elizabeth Blessing Elimimian ◽  
Rafael Arteta-Bulos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Cells ◽  
Late Stage ◽  
Early Stage ◽  
Disseminated Tumor Cells ◽  
Her2 Status ◽  
National Cancer Database ◽  
Factors Associated ◽  
Stage Disease ◽  
Chemotherapy Efficacy

Importance: Our understanding of the utility of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) as clinical biomarkers continues to evolve. Objective: This study evaluated (1) clinicopathologic factors associated with the presence of CTCs or DTCs, (2) the prognostic value of CTCs or DTCs by disease stage, 3), the value of these biomarkers in predicting the benefit of chemotherapy. Design: This is a retrospective analysis of patients with breast cancer (BC) diagnosed between 2004 and 2016 using the National Cancer Database (NCDB). To evaluate variables associated with the presence of CTCs or DTCs at the univariate level, we used chi-squared and Wilcoxon rank-sum tests. Multivariate logistic regression models were then constructed using significant variables. Consequently, we included CTC or DTC status (i.e. positive or negative) in multivariate, stage-by-stage Cox regression analyses for overall survival (OS). After stratifying by receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: Factors significantly associated with CTCs were race, progesterone receptor status, HER2 status, histology and AJCC N- and M-staging. Factors associated with DTCs were race, HER2 status, histology and AJCC N-staging. CTCs were associated with poor OS in late-stage (III and IV) but not early-stage (0-II) BC. DTCs were not significantly associated with OS in either context. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC status was positive, both in early-stage and late-stage disease. In a subset of patients without CTCs, however, chemotherapy conferred no survival benefit. DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a significant prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.

Prognostic and predictive effects of circulating and disseminated tumor cells in breast cancer: A National Cancer Database (NCDB) analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1029-1029
Author(s):  
Nadeem Bilani ◽  
Leah Elson ◽  
Rafael Arteta-Bulos ◽  
Elizabeth Blessing Elimimian ◽  
Hong Liang ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Late Stage ◽  
Early Stage ◽  
Disseminated Tumor Cells ◽  
National Cancer Database ◽  
Factors Associated ◽  
Chemotherapy Efficacy ◽  
Lobular Histology ◽  
N Staging ◽  
Her2 Positivity

1029 Background: Alongside other biomarkers, circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) could contribute to our growing understanding of the breast cancer (BC) “liquid biopsy”. This study evaluated 1) clinicopathologic factors associated with CTCs and DTCs, 2) the prognostic value of CTCs and DTCs by disease stage, 3), the efficacy of chemotherapy by CTC and DTC status. Methods: We conducted a retrospective analysis of BC using the 2004-2016 National Cancer Database (NCDB). The NCDB defines CTCs as isolated tumor cells (ITCs) found in the blood (using assays such as reverse transcriptase polymerase chain reaction or immunohistochemistry) distant from the breast. DTCs are ITCs found in the bone marrow or other non-regional tissues. To evaluate variables associated with CTCs or DTCs, we used chi-squared and Wilcoxon rank-sum tests (univariate), followed by multivariate logistic regression. Consequently, we included CTC or DTC status in a multivariate, stage-by-stage Cox regression analysis for overall survival (OS). After adjusting for receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: 4,846 cases reported CTC-status, 1,454 (21.1%) of which were positive. 4,993 cases reported DTC-status, 1,400 (20.3%) of which were positive. Factors associated with positive CTC status were HER2-positivity, progesterone receptor-positivity, lobular histology and N-staging. Factors associated with positive DTC status were being White, HER2-positivity, lobular histology and N-staging. Positive CTC-status was associated with poor OS overall in late-stage (III and IV) (HR 1.477, 95% CI: 1.129-1.931, p = 0.004) but not early-stage BC (0, I, II) (p = 0.110) disease. DTC-status was not associated with OS in early-stage or late-stage subsets. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC-status was also positive both in early-stage (p = 0.003) and late-stage (p = 0.023) disease. In a subset of the same BC subtype with negative CTC-status, however, chemotherapy conferred no survival benefit (p = 0.638 for early-stage, p = 0.501 for late-stage). DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a stronger prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.

Detection and prevalence of disseminated tumor cells from the bone marrow of early stage male breast cancer patients

2015 ◽  
Vol 152 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Andreas D. Hartkopf ◽  
Florin-Andrei Taran ◽  
Christina B. Walter ◽  
Markus Hahn ◽  
Tanja Fehm ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Male Breast Cancer ◽  
Early Stage ◽  
Disseminated Tumor Cells ◽  
Male Breast ◽  
Breast Cancer Patients

Comparison of HER2 status between primary tumor and disseminated tumor cells in␣primary breast cancer patients

2006 ◽  
Vol 98 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Erich F. Solomayer ◽  
Sven Becker ◽  
Graziella Pergola-Becker ◽  
Robert Bachmann ◽  
Bernhard Krämer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Primary Tumor ◽  
Primary Breast Cancer ◽  
Disseminated Tumor Cells ◽  
Her2 Status ◽  
Breast Cancer Patients

Sunitinib as adjuvant therapy for women with early-stage breast cancer and disseminated tumor cells in bone marrow.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 1094-1094
Author(s):  
J. Li ◽  
M. E. Melisko ◽  
P. N. Munster ◽  
M. Pelayo ◽  
M. M. Moasser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Adjuvant Therapy ◽  
Tumor Cells ◽  
Early Stage ◽  
Disseminated Tumor Cells ◽  
Early Stage Breast Cancer

Treg and Teff in the bone marrow of early-stage breast cancer patients with disseminated tumor cells.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. e21049-e21049
Author(s):  
D. G. Wolf ◽  
D. Fong ◽  
L. Scherrer ◽  
A. Wolf ◽  
D. Reimer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Early Stage ◽  
Disseminated Tumor Cells ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients

Frequency of late-stage breast cancer diagnoses despite high mammography screening rates in an HMO

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
R. Haque ◽  
J. E. Schottinger ◽  
M. H. Kanter ◽  
C. C. Avila ◽  
R. Contreras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Late Stage ◽  
Mammography Screening ◽  
Early Stage ◽  
Advanced Tumor Stage ◽  
Early Stage Disease ◽  
Advanced Tumor ◽  
Stage Disease ◽  
Late Stage Diagnosis ◽  
The Impact

1526 Background: Kaiser Permanente Southern California (KPSC) led the nation in screening women for breast cancer (BCa) with a mammography rate of nearly 90% in 2007 according to 2008 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Despite successes in improving screening rates in this health plan that serves 3+ million diverse members, the percentage of women diagnosed with late stage BCa (stage III, IV) remained stable, varying from 12.9% (N∼323) in 2003 to 10.8% (N∼270) in 2007. To identify patient and health care factors associated with late stage diagnosis and the impact of its enhanced screening implementation guidelines, KPSC undertook this study. Methods: This cross-sectional study included a cohort of 10,580 BCa patients from 2003–2007. We compared women diagnosed with late stage disease versus those with early stage disease (stages I, II). P values (2-sided) were based on the chi-square distribution. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Results: Factors that were positively associated with late stage diagnosis in the univariate analyses included age, lack of recent mammography screening, worse tumor features, 80+ years of age, minority race, lower geocoded household income, increased healthcare visits, and use of Pap testing (P < 0.01 for all variables). Factors significantly associated with late stage diagnosis in the multivariate model included only lack of recent mammography screening (OR = 1.35, 95% CI: 1.14–1.58) and worse tumor features including high grade (grade 3, OR = 2.58, 95% CI: 1.96–3.40), positive lymph nodes (OR = 53.49, 95% CI: 39.90–71.72), and HER-2+ tumors (OR = 1.40, 95% CI: 1.13–1.72). Conclusions: Targeting older women, those with lower utilization, and women who did not have a recent mammogram may help further lower the prevalence of late stage diagnoses. However, given the extent of the health plan's previous efforts to enhance BCa screening rates, a ceiling effect may limit additional benefit. Additional efforts to decrease the rate of advanced tumor stage at diagnosis may include improving interpretation of mammograms or earlier detection of aggressive tumors by enhanced BRCA genetic testing. No significant financial relationships to disclose.

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