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

patients with breast cancer is associated with poor outcomes. Recent studies demonstrated thatDTCsmay serve as aprognostic factor inovariancancer.Theaimof this 3-center studywas 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 can-cer 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 2 106 mononuclear cells. Dis-seminated 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 % con-fidence interval, 37Y65 months vs 33 months; 95 % confidence interval, 23Y43 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 o