Konsensusempfehlungen zu methodischen Aspekten und zur klinischen Relevanz des Nachweises disseminierter Tumorzellen (DTZ) im Knochenmark (KM) von Patientinnen mit primärem Mammakarzinom

Zusammenfassung

Das Gebiet der Tumorzelldissemination beim Mammakarzinom hatte in den letzten Jahren immer mehr an Bedeutung gewonnen. Durch den Nachweis disseminierter Tumorzellen im Knochenmark und Blut wurde bewiesen, dass das Mammakarzinom prinzipiell eine systemische Erkrankung ist. Die Daten der Pooled Analysis der Collaborative Bone Marrow Micrometastasis Group bestätigten den Tumorzellnachweis im Knochenmark als unabhängigen prognostischen Marker. Darüber hinaus ist die Prognose der Frauen mit Tumorzellpersistenz nach adjuvanter systemischer Therapie im Vergleich zu den Patientinnen ohne Tumorzellnachweis deutlich schlechter. In zukünftigen Studien müssen nun Therapieansätze evaluiert werden, die die Eliminierung disseminierte Tumorzellen zum Ziel haben. Eine entscheidende Vorraussetzung für die Durchführung von solchen (Multizenter-)studien ist, dass ein standardisiertes Vorgehen zum Nachweis von disseminierten Tumorzellen im Knochenmark definiert wird. Im Rahmen der Dreiländertagung der Gesellschaften für Senologie traf sich daher ein internationales Expertenpanel aus Deutschland, der Schweiz und aus Österreich, um die bestehenden Methoden zum Tumorzellnachweis im Knochenmark zu evaluieren sowie einen Konsensus für den standardisierten Nachweis sowie die klinische Implementierung festzulegen.

Abstract

Presence of disseminated tumor cells in blood and bone marrow (BM) has confirmed the hypothesis of breast cancer as a systemic disease. Disseminated tumor cells (DTC) are already present in 20 - 40 % of primary breast cancer patients without clinical evidence of metastatic disease. A large pooled analysis has recently shown that the presence of disseminated tumor cells in the bone marrow (BM) of primary breast cancer patients (stages I-III) is associated with poor prognosis. Moreover, tumor cell persistence after completion of adjuvant therapy identifies patients at a high risk for recurrence. To date, sampling of BM and assessment of DTC is not considered a routine procedure in the clinical management of breast cancer patients but emerging data suggests a future role for risk stratification and monitoring of therapeutic efficacy. Since these clinical options need to be evaluated in clinical trials, agreement on the standardized detection of DTC is mandatory. Therefore, the German, Austrian and Swiss Societies for Senology recently initiated an international consensus meeting 1) to define a consensus for the standardized detection of DTC and to explore the options for its clinical implementation.

Schlüsselwörter

Mammakarzinom - Tumorzelldissemination - Konsensustreffen - Prognose

Key words

breast cancer - tumor cell dissemination - consensus meeting - prognosis

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1 stellvertetend für die Kommission Tumorzelldissemination der Senologie

2 stellvertretend für DISMAL (Disseminated Malignancies) Projekt Konsortium (unterstützt durch das European Community's Framework programme, LSHC-CT-2005-018911)