Circulating tumor cells, disease progression, and survival in metastatic breast cancer - PubMed (original) (raw)
Clinical Trial
. 2004 Aug 19;351(8):781-91.
doi: 10.1056/NEJMoa040766.
Affiliations
- PMID: 15317891
- DOI: 10.1056/NEJMoa040766
Free article
Clinical Trial
Circulating tumor cells, disease progression, and survival in metastatic breast cancer
Massimo Cristofanilli et al. N Engl J Med. 2004.
Free article
Abstract
Background: We tested the hypothesis that the level of circulating tumor cells can predict survival in metastatic breast cancer.
Methods: In a prospective, multicenter study, we tested 177 patients with measurable metastatic breast cancer for levels of circulating tumor cells both before the patients were to start a new line of treatment and at the first follow-up visit. The progression of the disease or the response to treatment was determined with the use of standard imaging studies at the participating centers.
Results: Outcomes were assessed according to levels of circulating tumor cells at baseline, before the patients started a new treatment for metastatic disease. Patients in a training set with levels of circulating tumor cells equal to or higher than 5 per 7.5 ml of whole blood, as compared with the group with fewer than 5 circulating tumor cells per 7.5 ml, had a shorter median progression-free survival (2.7 months vs. 7.0 months, P<0.001) and shorter overall survival (10.1 months vs. >18 months, P<0.001). At the first follow-up visit after the initiation of therapy, this difference between the groups persisted (progression-free survival, 2.1 months vs. 7.0 months; P<0.001; overall survival, 8.2 months vs. >18 months; P<0.001), and the reduced proportion of patients (from 49 percent to 30 percent) in the group with an unfavorable prognosis suggested that there was a benefit from therapy. The multivariate Cox proportional-hazards regression showed that, of all the variables in the statistical model, the levels of circulating tumor cells at baseline and at the first follow-up visit were the most significant predictors of progression-free and overall survival.
Conclusions: The number of circulating tumor cells before treatment is an independent predictor of progression-free survival and overall survival in patients with metastatic breast cancer.
Copyright 2004 Massachusetts Medical Society
Comment in
- Circulating tumor cells in metastatic breast cancer--toward individualized treatment?
Braun S, Marth C. Braun S, et al. N Engl J Med. 2004 Aug 19;351(8):824-6. doi: 10.1056/NEJMe048163. N Engl J Med. 2004. PMID: 15317898 No abstract available. - Circulating epithelial cells in breast cancer.
Fiegl M, Denz H. Fiegl M, et al. N Engl J Med. 2004 Dec 2;351(23):2452-4; author reply 2452-4. doi: 10.1056/NEJM200412023512323. N Engl J Med. 2004. PMID: 15575068 No abstract available. - Circulating epithelial cells in breast cancer.
Voogd AC, van Gestel K, Ernst MF. Voogd AC, et al. N Engl J Med. 2004 Dec 2;351(23):2452-4; author reply 2452-4. N Engl J Med. 2004. PMID: 15580676 No abstract available. - Circulating epithelial cells in breast cancer.
Kunkler IH. Kunkler IH. N Engl J Med. 2004 Dec 2;351(23):2452-4; author reply 2452-4. N Engl J Med. 2004. PMID: 15580680 No abstract available. - Circulating epithelial cells in breast cancer.
Tang C, Lin AY. Tang C, et al. N Engl J Med. 2004 Dec 2;351(23):2452-4; author reply 2452-4. N Engl J Med. 2004. PMID: 15580681 No abstract available.
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