The Adjuvant Therapy Influence upon Micrometastasis in Bone Marrow Aspiration and Detection of Relapse Rate in Breast Cancer Patients Follow up

Abstract

Introduction: Breast cancers in the early phase frequently undergo distant metastasis and survival of patients is greatly dependent on distant metastasis. The occurrence of micrometastasis has been suggested to relate with prognostic features of breast cancer, such as lymph node metastasis and the presence of vascular invasion. The aim of this study was to examine the presence of keratin-19 mRNA of epithelial tumors in bone marrow aspirates obtained from breast cancer patients and its possible correlation with tumor staging and disease free survival.
Methods and materials: Bone marrow samples were obtained from 53 breast cancer patients at the time of adjuvant therapy after surgery. We separated the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction (RT-­PCR) .for the detection of keratin-19 mRNA with two different pairs of primers. After adjuvant therapy, patients undergoing Bone marrow aspiration and repeat separation the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction (RT-PCR) for the detection of keratin-19 mRNA with two different pairs of primers, the patients were followed up at 3-month intervals.(1,2) We studied the possible correlation of the detection of keratin-19 mRNA with tumor size, nodal involvement, stage and recurrence rate, overall survival and disease -free survival.
Results: We studies 53 Breast cancer patients (Stage 1-11I) for presence of Bone marrow micrometastasis by nested-PCR for cytokeratin 19. Before adjuvant chemotherapy it was positive in 17 patients (32%). Presence of DTC was independent to clinical stage. We followed 15 out of 17 bone marrow positive, by the same methods for presence of micrometastasis after adjuvant chemotherapy and observed that 4 patients remained positive after adjuvant chemotherapy.
Conclusion: With a median follow up of 272 days three metastasis developed, in our cohort which all happened in bone marrow positive patients. Our study is ongoing to increase the number of patients, longer follow up and also to compare peripheral blood with bone marrow.