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Clinical Trial
. 2017 May;6(5):918-927.
doi: 10.1002/cam4.1056. Epub 2017 Apr 12.

Presence of bone marrow micro-metastases in stage I-III colon cancer patients is associated with worse disease-free and overall survival

Carsten T Viehl  1   2 , Benjamin Weixler  2   3 , Ulrich Guller  4   5 , Salome Dell-Kuster  2   6 , Rachel Rosenthal  2 , Michaela Ramser  2 , Vanessa Banz  5 , Igor Langer  7 , Luigi Terracciano  8 , Guido Sauter  8   9 , Daniel Oertli  2 , Markus Zuber  3
Affiliations
Clinical Trial

Presence of bone marrow micro-metastases in stage I-III colon cancer patients is associated with worse disease-free and overall survival

Carsten T Viehl et al. Cancer Med. 2017 May.

Abstract

The prognostic significance of bone marrow micro-metastases (BMM) in colon cancer patients remains unclear. We conducted a prospective cohort study with long-term follow-up to evaluate the relevance of BMM as a prognostic factor for disease free (DFS) and overall survival (OS) in stage I-III colon cancer patients. In this prospective multicenter cohort study 144 stage I-III colon cancer patients underwent bone marrow aspiration from both iliac crests prior to open oncologic resection. The bone marrow aspirates were stained with the pancytokeratin antibody A45-B/B3 and analyzed for the presence of epithelial tumor cells. DFS and OS were analyzed using a Cox proportional hazard model and robust standard errors to account for clustering in the multicenter setting. Median overall follow-up was 6.2 years with no losses to follow-up, and 7.3 years in patients who survived. BMM were found in 55 (38%) patients. In total, 30 (21%) patients had disease recurrence and 56 (39%) patients died. After adjusting for known prognostic factors, BMM positive patients had a significantly worse DFS (hazard ratio [HR] 1.33; 95% confidence interval [95% CI]: 1.02-1.73; P = 0.037) and OS (HR 1.30; 95% CI: 1.09-1.55; P = 0.003) compared to BMM negative patients. Bone marrow micro-metastases occur in over one third of stage I-III colon cancer patients and are a significant, independent negative prognostic factor for DFS and OS. Future trials should evaluate whether node-negative colon cancer patients with BMM benefit from adjuvant chemotherapy.

Keywords: Bone marrow; colon cancer; micro-metastases; prognosis.

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Figures

Figure 1
Figure 1
CONSORT diagram. BMM, bone marrow micro‐metastases.
Figure 2
Figure 2
Cumulative incidence of recurrence or cancer‐related death (top) and not‐cancer related death for the covariates bone marrow (BM) negative and positive.
Figure 3
Figure 3
Kaplan–Meier survival curves for overall survival and disease‐free survival for the covariates bone marrow (BM) negative and positive.
See this image and copyright information in PMC

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