Influence of hematogenous tumor cell dissemination on patterns of relapse in patients with cervical carcinoma of the uterus.

e21148 Background: The presence of isolated tumor cells (ITC) in the bone marrow at the time of primary diagnosis has been found to indicate an increased risk for subsequent development of distant metastases in various solid tumors. In this study we evaluated the prevalence and prognostic significance of ITC in patients with primary carcinoma of the cervix uteri (Janni et al., Cancer 2003). Up-dated results are presented. Methods: Bone marrow aspirates of 133 patients with newly diagnosed carcinoma of the cervix uteri were immunocytochemically analyzed for the presence of cytokeratin(CK)-positive cells from May 1994 until July 2002. We used a quantitative immunoassay with the monoclonal anti-CK antibody A45-B/B3 and evaluated 2 x106 bone marrow cells per patient. Patients were followed prospectively for a median of 48 (range, 1-168) months. Results: ITC were found in the bone marrow of 39 patients (29%). The presence of ITC did not correlate with the FIGO tumor stage (p=0.61), or pelvic and paraaortal lymph node involvement (p=0.41), nor with invasion of peritumoral blood vessels (p=0.92). The bone marrow status at the time of primary diagnosis did not correlate with the overall survival as estimated by Kaplan-Meier-Analysis (p=0.31). Distant metastases occurred in 14.9% of the patients (n=14) with negative and in 15.4% of the patients (n=6) with positive bone marrow status (p= 1.0). The mean disease free survival was 139 months (126 – 152, 95% CI) in patients with negative, and 110 months (123 – 145) in patients with positive bone marrow status (p=0.13). Conclusions: In contrast to findings from earlier analyses with shorter follow-up time and compared to other tumor entities, the presence of ITC in the bone marrow of patients with cervical cancer does not indicate an increased risk for the development of distant metastases for these patients. Stratification for systemic treatment should not be based on the bone marrow status in this patient population.