Pooled Analysis of the Prognostic Relevance of Disseminated Tumor Cells in the Bone Marrow of Patients With Ovarian Cancer

Objective: Detection of disseminated tumor cells (DTCs) in the bone
marrow (BM) of patients with breast cancer is associated with poor
outcomes. Recent studies demonstrated that DTCs may serve as a
prognostic factor in ovarian cancer. The aim of this 3-center study
was to evaluate the impact of BM status on survival in a large
cohort of patients with ovarian cancer. Materials and Methods: Four
hundred ninety-five patients with primary ovarian cancer were
included in this 3-center prospective study. Bone marrow aspirates
were collected intraoperatively from the iliac crest. Disseminated
tumor cells were identified by antibody staining and by
cytomorphology. Clinical outcome was correlated with the presence
of DTCs. Results: Disseminated tumor cells were detected in 27% of
all BM aspirates. The number of cytokeratin-positive cells ranged
from 1 to 42 per 2 x 10(6) mononuclear cells. Disseminated tumor
cell status did correlate with histologic subtype but not with any
of the other established clinicopathologic factors. The overall
survival was significantly shorter among DTC-positive patients
compared to DTC-negative patients (51 months; 95% confidence
interval, 37-65 months vs 33 months; 95% confidence interval, 23-43
months; P = 0.023). In the multivariate analysis, BM status,
International Federation of Gynecology and Obstetrics stage, nodal
status, resection status, and age were independent predictors of
reduced overall survival, whereas only BM status, International
Federation of Gynecology and Obstetrics stage, and resection status
independently predicted progression-free survival. Conclusions:
Tumor cell dissemination into the BM is a common phenomenon in
ovarian cancer. Disseminated tumor cell detection has the potential
to become an important biomarker for prognostication and disease
monitoring in patients with ovarian cancer.