Evidence map›Paper›PMID 24832787›Full record

Trial reportJournal of the National Cancer Institute2014

Circulating tumor cells predict survival in early average-to-high risk breast cancer patients.

Brigitte Rack, Christian Schindlbeck, Julia Jückstock, Ulrich Andergassen, Philip Hepp, Thomas Zwingers, Thomas W P Friedl, Ralf Lorenz, Hans Tesch, Peter A Fasching and 8 more

Erratum issuedOpen access · hybridAbstract readClinical Trial, Phase IIIRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the National Cancer Institute, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 298 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
298citing papers in PubMed, 1 pooled it
31.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

298 citing papers in PubMed, 1 synthesis or guideline pooled it, 601 citations in OpenAlex.

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  19. Red blood cell-tumor cell interactions promote tumor cell progression.Journal of experimental & clinical cancer research : CR · 2025
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238 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 1 institution in 1 country.

Brigitte RackAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ). brigitte.rack@med.uni-muenchen.de.
Christian SchindlbeckAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Julia JückstockAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Ulrich AndergassenAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Philip HeppAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Thomas ZwingersAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Thomas W P FriedlAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Ralf LorenzAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Hans TeschAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Peter A FaschingAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Tanja FehmAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Andreas SchneeweissAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Werner LichteneggerAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Matthias W BeckmannAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Klaus FrieseAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Klaus PantelAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
Wolfgang JanniAffiliations of authors: Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany (BR, JJ, UA, KF); Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany (CS); Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany (PH, TF); Augsburg, Germany (TZ); Braunschweig, Germany (RL); Frankfurt, Germany (HT); National Center for Tumor Diseases, University Hospital, Heidelberg, Germany (AS); Charité University Hospital Campus Virchow, Berlin, Germany (WL); Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany (PAF, MWB); Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (KP); Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany (TWPF, WJ).
SUCCESS Study Group
Ludwig-Maximilians-Universität München · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCirculating tumor cells (CTCs) have been shown to predict reduced survival outcomes in metastatic breast cancer.

methodsCTCs were analyzed in 2026 patients with early breast cancer before adjuvant chemotherapy and in 1492 patients after chemotherapy using the CellSearch System. After immuno-magnetic enrichment for cells expressing the epithelial-cell adhesion molecule, CTCs were defined as nucleated cells expressing cytokeratin and lacking CD45. The patients were followed for a median of 35 months (range = 0-54). Kaplan-Meier analyses and the log-rank test were used for survival analyses. All statistical tests were two-sided.

resultsBefore chemotherapy, CTCs were detected in 21.5% of patients (n = 435 of 2026), with 19.6% (n = 136 of 692) of node-negative and 22.4% (n = 299 of 1334) of node-positive patients showing CTCs (P < .001). No association was found with tumor size, grading, or hormone receptor status. After chemotherapy, 22.1% of patients (n = 330 of 1493) were CTC positive. The presence of CTCs was associated with poor disease-free survival (DFS; P < .0001), distant DFS (P < .001), breast cancer-specific survival (P = .008), and overall survival (OS; P = .0002). CTCs were confirmed as independent prognostic markers in multivariable analysis for DFS (hazard ratio [HR] = 2.11; 95% confidence interval [CI] = 1.49 to 2.99; P < .0001) and OS (HR = 2.18; 95% CI = 1.32 to 3.59; P = .002). The prognosis was worst in patients with at least five CTCs per 30 mL blood (DFS: HR = 4.51, 95% CI = 2.59 to 7.86; OS: HR = 3.60, 95% CI = 1.56 to 8.45). The presence of persisting CTCs after chemotherapy showed a negative influence on DFS (HR = 1.12; 95% CI = 1.02 to 1.25; P = .02) and on OS (HR = 1.16; 95% CI = 0.99 to 1.37; P = .06)

conclusionsThese results suggest the independent prognostic relevance of CTCs both before and after adjuvant chemotherapy in a large prospective trial of patients with primary breast cancer.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsChemotherapy, AdjuvantCyclophosphamideDeoxycytidineDocetaxelEpirubicinFemaleFluorouracilGemcitabineHumansImmunomagnetic SeparationKaplan-Meier EstimateLymphatic MetastasisMiddle AgedNeoplasm StagingCyclophosphamideDeoxycytidineDocetaxelEpirubicinFluorouracilGemcitabineTaxoids

Identifiers

PMID24832787
PMCPMC4112925
OpenAlexW2169632044

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