Breast Cancer Research and Treatment

, Volume 165, Issue 3, pp 733–741 | Cite as

Prognostic values of cancer associated macrophage-like cells (CAML) enumeration in metastatic breast cancer

  • Zhaomei MuEmail author
  • Chun Wang
  • Zhong Ye
  • Giovanna Rossi
  • Carl Sun
  • Ling Li
  • Zhu Zhu
  • Hushan Yang
  • Massimo CristofanilliEmail author



Circulating cancer associated macrophage-like cells (CAMLs) have been detected in the peripheral blood of patients with solid tumors including breast cancer. However, the prognostic relevance of CAMLs in metastatic breast cancer (MBC) has not been evaluated. In the present study, we aimed to measure CAMLs and circulating tumor cells (CTCs) at baseline and examine their prognostic value in patients with MBC.


Peripheral blood samples from 127 MBC patients were collected at baseline before starting a new treatment. The detection and enumeration of CAMLs and CTCs in 7.5 ml whole blood were performed using the CellSearch™ system. The associations of CAMLs and CTCs with the progression-free survival (PFS) and overall survival (OS) in the patients were evaluated using Kaplan–Meier curves and Cox proportional hazards modeling.


Among 127 MBC patients, 21 (16.5%) were detected with CAMLs and 38 (29.9%) had elevated CTCs (≥5 CTCs/7.5 ml). Patients with CAMLs at baseline had worse PFS and OS with an adjusted hazard ratio (HR) of 1.75 (95% CI 1.03–2.98, P = 0.0374) and 3.75 (95% CI 1.52–9.26, P = 0.0042), compared to patients without CAMLs. Compared with patients with <5 CTCs and without CAMLs, patients with <5 CTCs and with CAMLs, with ≥5 CTCs but without CAMLs, or with ≥5 CTCs and with CAMLs, had an increasing trend of risk of disease progression (HR = 0.84, 3.42 and 4.04 respectively, P for trend <0.0001) and death (HR = 2.66, 6.14, and 9.13, respectively, P for trend <0.0001).


Baseline enumeration of individual CAMLs is an independent indicator for MBC patients’ survival. Evaluation of CAMLs in peripheral blood might provide a potential biomarker with additional prognostic values over CTC enumeration alone in MBC patients.


Metastatic breast cancer (MBC) Circulating cancer associated macrophage-like cells (CAMLs) Circulating tumor cells (CTCs) Prognosis Progression-free survival (PFS) Overall survival (OS) 



The work reported in this study received supports from Thomas Jefferson University, The Inflammatory Breast Cancer Network Foundation, and the Lynn Sage Breast Cancer Research Foundation.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Medicine-Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Department of Medical Oncology, Sidney Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Division of Thoracic OncologyEuropean Institute of OncologyMilanItaly

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