Email updates

Keep up to date with the latest news and content from Breast Cancer Research and BioMed Central.

Open Access Highly Accessed Research article

Circulating tumor cells, disease recurrence and survival in newly diagnosed breast cancer

Bas Franken1, Marco R de Groot1, Walter JB Mastboom2, Istvan Vermes3, Job van der Palen45, Arjan GJ Tibbe6 and Leon WMM Terstappen7*

Author Affiliations

1 Department of Internal Medicine, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513 ER, The Netherlands

2 Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513 ER, The Netherlands

3 Department of Clinical Chemistry, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513 ER, The Netherlands

4 Department of Epidemiology, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513 ER, The Netherlands

5 Department of Research Methodology, Measurement and Data Analysis, University of Twente, Drienerlolaan 5 Enschede, 7522 NB, The Netherlands

6 VyCAP, Abraham Rademakerstraat 41, Deventer, 7425 PG, The Netherlands

7 Medical Cell BioPhysics group, MIRA Institute, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands

For all author emails, please log on.

Breast Cancer Research 2012, 14:R133  doi:10.1186/bcr3333

Published: 22 October 2012

Abstract

Introduction

The presence of circulating tumor cells (CTC) is an independent prognostic factor for progression-free survival and breast cancer-related death (BRD) for patients with metastatic breast cancer beginning a new line of systemic therapy. The current study was undertaken to explore whether the presence of CTC at the time of diagnosis was associated with recurrence-free survival (RFS) and BRD.

Methods

In a prospective single center study, CTC were enumerated with the CellSearch system in 30 ml of peripheral blood of 602 patients before undergoing surgery for breast cancer. There were 97 patients with a benign tumor, 101 did not meet the inclusion criteria of which there were 48 patients with DCIS, leaving 404 stage I to III patients. Patients were stratified into unfavorable (CTC ≥1) and favorable (CTC = 0) prognostic groups.

Results

1 CTC in 30 ml blood was detected in 15 (15%) benign tumors, in 9 DCIS (19%), in 28 (16%) stage I, 32 (18%) stage II and in 16 (31%) patients with stage III. In stage I to III patients 76 (19%) had
1 CTC of whom 16 (21.1%) developed a recurrence. In 328 patients with 0 CTC 38 (11.6%) developed a recurrence. Four-year RFS was 88.4% for favorable CTC and 78.9% for unfavorable CTC (P = 0.038). A total of 25 patients died of breast cancer-related causes and 11 (44%) had
1 CTC. BRD was 4.3% for favorable and 14.5% for unfavorable CTC (P = 0.001). In multivariate analysis ≥1 CTC was associated with distant disease-free survival, but not for overall recurrence-free survival. CTC, progesterone receptor and N-stage were independent predictors of BRD in multivariate analysis.

Conclusions

Presence of CTC in breast cancer patients before undergoing surgery with curative intent is associated with an increased risk for breast cancer-related death.