Is immunohistochemical analysis an appropriate diagnostic technique for bone marrow micrometastases?

Noncolonic cancer stem cells in bone marrow of colorectal cancer patients

OBJECTIVE

To investigate whether preoperative noncolonic cancer stem cells in bone marrow (BM) of R0 colorectal cancer (CRC) patients are cancer cells and impact on liver metastases (LM) rates.

METHOD

Prospective data on continuous CRC patients were collected from five centres. Bone marrow aspirates, taken at laparotomy, were sent to a single lab. Noncolonic cancer stem cells were defined according to UICC. A quantity of 3 x 10(6) BM cells per patient was processed with monoclonal antibodies against cytokeratin 20. APC or p53 gene mutation and microsatellite instability (MSI) were assessed in primary tumours (PT) by single-strand conformation polymorphism. Noncolonic cancer stem cells in BM of PT mutation or MSI-positive patients were isolated with immunobeads coated with magnetically labelled anti-human epithelial antigen antibody and DNA-screened for mutations.

RESULTS

Although 199 patients were enrolled, 162 patients were available for analysis. No patients were lost to follow-up. Twenty-five (2-170) noncolonic cancer stem cells were found in BM of 40 patients. Twenty-two patients developed LM at 36-month follow-up. Adenomatous polyposis coli (APC) or p53 gene mutation or MSI were identified in the PT of 78 patients. The same gene mutations or MSI were not found in noncolonic cancer stem cells of the BM of these patients. After adjustment, there was no significant effect of confounding factors. Noncolonic cancer stem cells in BM had no impact on LM rates, cancer-specific death rates, or all death rates.

CONCLUSIONS

Preoperative noncolonic cancer stem cells in BM of R0 CRC patients were not cancer cells and had no impact on LM rates.

[Prognostic and predictive factors of invasive breast cancer: update 2009]

Prognostic factors supply information on the course of a disease (recurrence-free and total survival) and are independent of the therapy. The most important prognostic factors are lymph node status, tumor diameter and histological differentiation stage, lymph and blood vessel invasion as well as staging, factors which can all be determined by pathologists. The Nottingham prognostic index (NPI) combines the strongest prognostic factors and according to study results is a suitable model for prognosis of breast cancer. Predictive factors give prior information on the probability of the response of a tumor to a defined therapy and include hormone receptor status, the invasion marker uPA/PAI-1, detection of isolated tumor cells, a residual tumor and the histological resection border.Prognostic or predictive factors are clinically relevant when therapy decisions are made possible by their recognition, which lead to an improvement in the total survival, recurrence-free survival or quality of life. The international consensus recommendation of St. Gallen 2007 requires the following as a basis for risk-adapted therapy decisions: tumor size, stage, age, nodal status, hormone receptor status and Her2 overexpression or amplification status.

American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer

PURPOSE

To update the recommendations for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast cancer.

METHODS

For the 2007 update, an Update Committee composed of members from the full Panel was formed to complete the review and analysis of data published since 1999. Computerized literature searches of MEDLINE and the Cochrane Collaboration Library were performed. The Update Committee's literature review focused attention on available systematic reviews and meta-analyses of published tumor marker studies. In general, significant health outcomes (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used for making recommendations. Recommendations and

CONCLUSIONS

Thirteen categories of breast tumor markers were considered, six of which were new for the guideline. The following categories showed evidence of clinical utility and were recommended for use in practice: CA 15-3, CA 27.29, carcinoembryonic antigen, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, urokinase plasminogen activator, plasminogen activator inhibitor 1, and certain multiparameter gene expression assays. Not all applications for these markers were supported, however. The following categories demonstrated insufficient evidence to support routine use in clinical practice: DNA/ploidy by flow cytometry, p53, cathepsin D, cyclin E, proteomics, certain multiparameter assays, detection of bone marrow micrometastases, and circulating tumor cells.