Circulating tumor cells in metastatic breast cancer: clinical relevance and biological potential.

PURPOSE OF REVIEW: The possibility of tumor dissemination through the blood system has been known for years. Circulating tumor cells (CTCs) are detectable in the peripheral blood of patients with early as well as metastatic breast cancer. The prognostic relevance of this biomarker has already been described. By the use of repeated blood sampling along the course of disease, CTCs can be monitored in terms of a regular 'liquid biopsy'. This review aims to summarize recent research findings and actual ongoing clinical studies to demonstrate the actual and future relevance of CTCs in daily clinical routine. RECENT FINDINGS: Recent research results show that additional molecular analysis of CTCs might be helpful in gaining information about tumor characteristics, tumor heterogeneity and possible therapy resistance. Repetitive invasive core biopsies might be avoided. SUMMARY: The assessment of molecular attributes may be indispensable for obtaining an optimized and personalized therapy aiming at extended survival and/or improved quality of life.

Results of an internal audit on the survival of patients with uterine sarcoma

Objective: In the last 5 years there has been much discussion about the surgical procedure for uterine fibroids, and essentially, also uterine sarcoma. Still there exists no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of this study was to confirm the suspected association between intraoperative spread of tumor by morcellation and impaired outcomes in patients with sarcoma. Material and Methods: After the local ethics commission positively reviewed the study protocol, the oncologic database of our university hospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted from the medical files and survival information was collected by contacting the patient's general practitioners if last follow-up-status was older than 6 months. For the analysis, patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regarding information provided by the surgical report. Results: Data on 57 patients with uterine sarcoma were available for further analysis. The median age and body mass index of the patients was 63 years and 27 kg/m², respectively. The sarcoma subtypes were 25 leiomyosarcoma, 19 carcinosarcoma, 9 endometrioid stroma sarcoma, 3 adenosarcoma, and one case without further differentiation. In the majority, no morcellation was performed (M- group, n=44) and 51 patients received open surgery (3 laparoscopic, 1 vaginal, and 2 incomplete surgeries). The median time of follow-up was 31 months. The disease-free survival was 50.5 months and the Cox regression analysis showed a hazard ratio of 3.06 [no significant difference between the two subgroups (p=0.079; 95% confidence interval (CI): 0.9-10.6)]. The overall survival was found as 62.2 months and the Cox regression analysis showed a hazard ratio of 3.216 with a statistically significant difference between the two subgroups (p=0.013; 95% CI: 1.3-8.1). Conclusion: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence is low during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 of 57). If sarcoma is suspected or diagnosed then en-bloc resection of the uterus can prolong survival. Thus, morcellation of the uterus and not the surgical technique (en-bloc resection) is the prognostic factor and should be avoided in any suspicious case.