Prognostic Significance of Disseminated Tumor Cells in Bone Marrow for Endometrial Carcinoma Patients

Abstract

Background: Until now, limited clinical significance had been reported for disseminated tumor cells (DTCs) in gynecologic malignancies. DTCs were previously reported not to be associated with established risk factors, L1CAM immunoreactivity, and outcome in endometrial carcinoma (EC). This study's primary objective was to investigate potential correlations of DTCs in the bone marrow (BM) of EC patients with disease-related survival, and a secondary objective was to evaluate associations between molecular classification of EC and DTCs. Methods: Patients treated for primary EC at Tuebingen University women's hospital between 2003 and 2016 were identified. A total of 402 patients with a complete set of BM cytology, molecular, and clinical data were evaluable. Results: DTC occurrence was distributed equally among all four molecular groups (p = 0.651). DTC positivity was associated with a less favorable disease-free survival (HR: 1.86, 95% CI: 1.03-3.36, p = 0.036) and progression-free survival (HR: 1.86, 95% CI: 1.01-3.44, p = 0.045). Presence of DTCs was associated with a higher frequency of distant disease recurrence (p = 0.017). Conclusions: In line with our previous findings, tumor cell dissemination is not associated with molecular features in our large cohort of primary EC patients. Since DTCs seem to be associated with survival and location of disease recurrence, further studies are needed to decisively define their role in EC survival.

Keywords: ProMisE classification; disseminated tumor cells; endometrial cancer; minimal residual disease; molecular classification.

Figure 1

Univariate survival analysis by disseminated tumor cell (DTC) status. Kaplan–Maier plots of (A) disease-specific survival (DSS) and (B) progression-free survival for DTC detection in bone marrow samples of patients with endometrial carcinoma.

Figure 2

Univariate survival analysis by disseminated tumor cell (DTC)-status. Kaplan–Maier plot of progression-free survival for DTC detection in bone marrow samples of endometrial carcinoma patients classified as MMRd.