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Estrogen receptor profile of patients with breast cancer metastatic to bone marrow
Insights
Estrogen receptor (ER) status in breast cancer patients with bone marrow metastasis is often positive. Bone marrow involvement correlates with cortical bone metastasis, suggesting ER-positive tumors favor bone spread.
Area of Science:
- Oncology
- Endocrinology
Background:
- Estrogen receptor (ER) status is crucial for breast cancer prognosis and treatment.
- Limited data exists on ER profiles in breast cancer patients with bone marrow metastasis.
Purpose of the Study:
- To investigate the estrogen receptor (ER) profile of breast cancer patients with bone marrow (BM) involvement.
- To explore the relationship between ER status and patterns of metastasis in breast cancer.
Main Methods:
- Retrospective chart review of breast cancer patients undergoing bone marrow aspiration or biopsy.
- Analysis of estrogen receptor (ER) levels in primary or metastatic tumor specimens.
- Documentation of metastatic sites (bone, liver, lung, CNS) and hematologic/biochemical abnormalities.
Main Results:
- Of 28 patients with known ER, 54% had ER levels > 10 fmoles/mg cytosol protein.
- 92% of patients with BM involvement also had cortical bone involvement.
- Elevated alkaline phosphatase (77%) and low hemoglobin (57%) were common findings.
Conclusions:
- Breast cancer bone marrow metastases are frequently associated with positive estrogen receptor (ER) status.
- ER-positive breast cancer shows a predilection for metastasizing to cortical bone.
- Bone marrow involvement is closely linked to cortical bone metastasis in ER-positive breast cancer.
Abstract:
The estrogen receptor (ER) profile of patients with breast cancer metastatic to bone marrow (BM) has not been widely reported. The charts of all patients having a diagnosis of breast cancer and undergoing bone marrow aspiration or biopsy at the Cleveland Clinic during the period of January 1980 through September 1982 were reviewed. Thirty-nine patients were so identified; of these 39 patients, 28 had estrogen receptor determination performed on a primary or a metastatic tumor specimen. Of the 28 patients with known ER, ten (36%) had ER less than 5 fmoles/mg cytosol protein, three (11%) had ER or 5 to 10 fmoles/mg, and 15 (54%) had ER greater than 10 fmoles/mg. Of the 39 patients with BM involvement, 36 (92%) had cortical bone involvement documented on x-ray or isotopic bone scan. Liver involvement was documented in 6/34 (18%) patients, pulmonary involvement in 14/37 (38%) patients, CNS relapses in 3/39 (8%), and locoregional recurrences in 19/39 (49%). The most significant hematologic finding was a hemoglobin of less than 12 gm% in 21/37 (57%). The most frequent biochemical abnormality was an elevation of the alkaline phosphatase in 30/39 (77%). The majority of breast cancer patients have a positive ER and ER-positive breast cancer has a tendency to metastasize to cortical bone. Bone marrow involvement by breast cancer is closely associated with cortical bone involvement; accordingly, bone marrow metastases are often associated with a positive ER.