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Tokunaga E, Koi Y, Tajiri W, Koga C, Ijichi H, Akiyoshi S, Kawasaki J, Nakamura Y, Taguchi K, Okamoto M. The impact of breast surgery and systemic therapy on the survival of patients with de novo stage IV breast cancer. Breast Cancer 2025; 32:426-433. [PMID: 39893610 PMCID: PMC11842408 DOI: 10.1007/s12282-025-01675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 01/28/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Systemic therapy (ST) is essential for de novo stage IV breast cancer (BC). Stage IV BCs are highly heterogeneous, and it seems inappropriate to treat all de novo stage IV BCs equally. The survival benefit of surgery for primary sites in patients with de novo stage IV BC remains inconclusive. PATIENTS AND METHODS We investigated 220 patients with clinical de novo stage IV BC. The relationship between primary site surgery and overall survival (OS) was analyzed. Factors such as tumor subtype, timing of surgery, and efficacy of ST were also evaluated. RESULTS The median follow-up time was 37.9 (0.5-201.7) months. In the total cohort, the median OS of the patients with and without primary site surgery was 70.5 months (95% confidence interval [CI] 58.4-107.3) and 42.7 months (95% CI 35.7-48.8), respectively. The OS was significantly longer in patients who underwent primary site surgery, especially in the hormone receptor (HR) + /HER2- and HER2 + subtypes, but not in the triple-negative subtype. OS prolongation was significant in patients who underwent surgery ≥ 24 months after the first diagnosis and in whom the first-line ST was effective for ≥ 24 months. Primary site surgery was a good prognostic factor in both univariate and multivariate analyses. CONCLUSIONS The OS was significantly longer in patients with de novo stage IV BC who underwent primary site surgery than in those who did not undergo surgery. Our results suggest that the tumor subtypes, efficacy of ST, and timing of surgery influenced the benefits of surgery.
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Affiliation(s)
- Eriko Tokunaga
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan.
| | - Yumiko Koi
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Wakako Tajiri
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Chinami Koga
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Hideki Ijichi
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Sayuri Akiyoshi
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Junji Kawasaki
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yoshiaki Nakamura
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Kenichi Taguchi
- Departments of Pathology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Masahiro Okamoto
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
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Liu LL, Lin YK, Xiang ZL. The Value of Primary Tumor Resection in Patients with Liver Metastases: A 10-Year Outcome. Ann Surg Oncol 2025; 32:1083-1092. [PMID: 39496900 PMCID: PMC11698763 DOI: 10.1245/s10434-024-16386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/07/2024] [Indexed: 11/06/2024]
Abstract
OBJECTIVE This study aimed to analyze the impact of primary tumor resection (PTR) on the prognosis of four common primary tumors with liver metastases, and to develop a prognostic model to visualize the PTR benefit rate of patients with liver metastases. MATERIALS AND METHODS Patients diagnosed with colorectal cancer liver metastases (CRLM), pancreatic cancer liver metastases (PLM), gastric cancer liver metastases (GLM), and breast cancer liver metastases (BLM) between 2004 and 2015 were retrospectively reviewed from the Surveillance, Epidemiology, and End Results (SEER) database and assigned to either the surgery or non-surgery groups. A 1:1 propensity score matching (PSM) was performed. Surgical patients who survived longer than the median cancer-specific survival (CSS) time for non-surgery patients constituted the benefit group. Logistic regression was conducted to explore the independent factors affecting surgical benefit, and a nomogram was established. RESULTS A total of 21,928 patients with liver metastases were included. After PSM for surgery and non-surgery patients, we found that PTR had a significant impact on the overall survival (OS) and CSS of CRLM, PLM, and BLM patients. In CRLM patients, age (p < 0.001), primary site (p = 0.006), grade (p = 0.009), N stage (p = 0.034), and histology (p = 0.006) affected the surgical benefit. In BLM patients, the independent factors were age (p = 0.002), race (p = 0.020), and radiotherapy (p = 0.043). And in PLM patients, chemotherapy was an independent factor associated with a survival benefit from PTR. CONCLUSION PTR improved OS and CSS in patients with CRLM, PLM, and BLM. A predictive model was established to identify suitable candidates for PTR in CRLM patients.
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Affiliation(s)
- Lin-Lin Liu
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Kun Lin
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zuo-Lin Xiang
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Zouki DN, Karatrasoglou EA, Pilichos G, Papadimitraki E. Oligometastatic Breast Cancer: Seeking the Cure by Redefining Stage IV Disease? Curr Treat Options Oncol 2024; 25:1482-1494. [PMID: 39541082 DOI: 10.1007/s11864-024-01275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2024] [Indexed: 11/16/2024]
Abstract
OPINION STATEMENT Breast cancer represents one of the most common malignancies worldwide. In early stages a combination of treatment strategies are offered with curative intent, whereas the therapeutic aim in metastatic disease is to provide the longest possible survival with an acceptable quality of life. The term "oligometastasis", first described by Hellmann and Weichselbaum in 1995, represents an intermediate state between local and systemic disease, where radical focal treatments to all metastatic lesions might have a curative potential. Due to sufficient lack of data, the proper management of oligometastatic disease remains even until today a highly unmet need. Surgery, radiotherapy or ablation (radiofrequency or cryotherapy) are among the local eradication therapies that could offer long-term outcomes in patients with oligometastatic breast cancer (OMBC). The present review aims to bring the readers up to the latest data regarding the management of OMBC according to the different organs involved by setting a framework of current treatment paradigms. It also brings to the forefront debatable questions requiring multidisciplinary approach and highlights the concerns arising from dealing with this clinically and biologically unique entity in everyday clinical practice.
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Affiliation(s)
- Dionysia N Zouki
- Breast Unit, University College London Hospitals NHS Foundation Trust, London, UK.
| | | | - Georgios Pilichos
- Department of Surgery, Karlstad Central Hospital, Rosenborgsgatan 9, 65230, Karlstad, Sweden
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Sugihara R, Watanabe H, Matsushima S, Katagiri Y, Saku S, Okabe M, Takao Y, Iwakuma N, Ogo E, Fujita F, Toh U. The effective duration of systemic therapy and the neutrophil-to-lymphocyte ratio predict the surgical advantage of primary tumor resection in patients with de novo stage IV breast cancer: a retrospective study. World J Surg Oncol 2024; 22:300. [PMID: 39543698 PMCID: PMC11562720 DOI: 10.1186/s12957-024-03586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 11/05/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND The primary tumor resection (PTR) of de novo stage IV breast cancer (DnIV BC) is controversial, and previous studies have suggested that the neutrophil-to-lymphocyte ratio (NLR) could be a poor-prognosis factor for BC. We investigated PTR's surgical advantage related to clinical outcomes, the surgery timing in responders to systemic therapy, and whether the NLR can predict the benefit of surgery for DnIV BC. PATIENTS AND METHODS We retrospectively analyzed the cases of the DnIV BC patients who received systemic therapies and/or underwent PTR at our institution between January 2004 and December 2022. Blood tests and NLR measurement were performed before and after each systematic therapy and/or surgery. RESULTS Sixty patients had undergone PTR local surgery (Surgery group); 81 patients had not undergone surgical treatment (Non-surgery group). In both groups, systemic treatment was performed as chemotherapy (95%) and/or endocrine therapy (92.5%) (p < 0.0001). The groups' respective median progression-free survival (PFS) durations were 88 and 30.3 months (p = 0.004); their overall survival (OS) durations were 100.1 and 31.8 months (p = 0.0002). The Surgery-group responders to systemic therapy lasting > 8.1-months showed significantly longer OS (p = 0.044). The PFS and OS were significantly associated with the use of postoperative systemic therapy (p = 0.0012) and the NLR (p = 0.018). A low NLR (≤ 3) was associated with significantly better prognoses (PFS and OS; p < 0.0001). CONCLUSIONS A longer effective duration of systemic therapy (> 8.1 months) and a low pre-surgery NLR (≤ 3.0) could predict PTR's surgical advantage for DnIV BC. These variables may help guide decisions regarding the timing of surgery for DnIV BC.
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Affiliation(s)
- Rie Sugihara
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Hidetaka Watanabe
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shuntaro Matsushima
- Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, Japan
| | - Yuriko Katagiri
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shuko Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Mina Okabe
- Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, Japan
| | - Yuko Takao
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Nobutaka Iwakuma
- Department of Breast Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
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Shi X, Wang X, Yao W, Shi D, Shao X, Lu Z, Chai Y, Song J, Tang W, Wang X. Mechanism insights and therapeutic intervention of tumor metastasis: latest developments and perspectives. Signal Transduct Target Ther 2024; 9:192. [PMID: 39090094 PMCID: PMC11294630 DOI: 10.1038/s41392-024-01885-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
Metastasis remains a pivotal characteristic of cancer and is the primary contributor to cancer-associated mortality. Despite its significance, the mechanisms governing metastasis are not fully elucidated. Contemporary findings in the domain of cancer biology have shed light on the molecular aspects of this intricate process. Tumor cells undergoing invasion engage with other cellular entities and proteins en route to their destination. Insights into these engagements have enhanced our comprehension of the principles directing the movement and adaptability of metastatic cells. The tumor microenvironment plays a pivotal role in facilitating the invasion and proliferation of cancer cells by enabling tumor cells to navigate through stromal barriers. Such attributes are influenced by genetic and epigenetic changes occurring in the tumor cells and their surrounding milieu. A profound understanding of the metastatic process's biological mechanisms is indispensable for devising efficacious therapeutic strategies. This review delves into recent developments concerning metastasis-associated genes, important signaling pathways, tumor microenvironment, metabolic processes, peripheral immunity, and mechanical forces and cancer metastasis. In addition, we combine recent advances with a particular emphasis on the prospect of developing effective interventions including the most popular cancer immunotherapies and nanotechnology to combat metastasis. We have also identified the limitations of current research on tumor metastasis, encompassing drug resistance, restricted animal models, inadequate biomarkers and early detection methods, as well as heterogeneity among others. It is anticipated that this comprehensive review will significantly contribute to the advancement of cancer metastasis research.
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Affiliation(s)
- Xiaoli Shi
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Xinyi Wang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wentao Yao
- Department of Urology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China
| | - Dongmin Shi
- Department of Medical Oncology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xihuan Shao
- The Fourth Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhengqing Lu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China
| | - Yue Chai
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China
| | - Jinhua Song
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China.
| | - Weiwei Tang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China.
| | - Xuehao Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Hepatobiliary Cancers, Nanjing, Jiangsu, China.
- School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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Zhu E, Zhang L, Wang J, Hu C, Jing Q, Shi W, Xu Z, Ai P, Dai Z, Shan D, Ai Z. Personalized surgical recommendations and quantitative therapeutic insights for patients with metastatic breast cancer: Insights from deep learning. CANCER INNOVATION 2024; 3:e119. [PMID: 38947759 PMCID: PMC11212336 DOI: 10.1002/cai2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 07/02/2024]
Abstract
Background The role of surgery in metastatic breast cancer (MBC) is currently controversial. Several novel statistical and deep learning (DL) methods promise to infer the suitability of surgery at the individual level. Objective The objective of this study was to identify the most applicable DL model for determining patients with MBC who could benefit from surgery and the type of surgery required. Methods We introduced the deep survival regression with mixture effects (DSME), a semi-parametric DL model integrating three causal inference methods. Six models were trained to make individualized treatment recommendations. Patients who received treatments in line with the DL models' recommendations were compared with those who underwent treatments divergent from the recommendations. Inverse probability weighting (IPW) was used to minimize bias. The effects of various features on surgery selection were visualized and quantified using multivariate linear regression and causal inference. Results In total, 5269 female patients with MBC were included. DSME was an independent protective factor, outperforming other models in recommending surgery (IPW-adjusted hazard ratio [HR] = 0.39, 95% confidence interval [CI]: 0.19-0.78) and type of surgery (IPW-adjusted HR = 0.66, 95% CI: 0.48-0.93). DSME was superior to other models and traditional guidelines, suggesting a higher proportion of patients benefiting from surgery, especially breast-conserving surgery. The debiased effect of patient characteristics, including age, tumor size, metastatic sites, lymph node status, and breast cancer subtypes, on surgery decision was also quantified. Conclusions Our findings suggested that DSME could effectively identify patients with MBC likely to benefit from surgery and the specific type of surgery needed. This method can facilitate the development of efficient, reliable treatment recommendation systems and provide quantifiable evidence for decision-making.
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Affiliation(s)
- Enzhao Zhu
- School of MedicineTongji UniversityShanghaiChina
| | - Linmei Zhang
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Research Institute of Stomatology, Stomatological Hospital and Dental School of Tongji UniversityShanghaiChina
| | - Jiayi Wang
- School of MedicineTongji UniversityShanghaiChina
| | - Chunyu Hu
- Tenth People's Hospital of Tongji University, School of MedicineTongji UniversityShanghaiChina
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Weizhong Shi
- Shanghai Hospital Development CenterShanghaiChina
| | - Ziqin Xu
- Columbia UniversityNew YorkNYUSA
| | - Pu Ai
- School of MedicineTongji UniversityShanghaiChina
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Dan Shan
- Department of Biobehavioral SciencesColumbia UniversityNew YorkNYUSA
| | - Zisheng Ai
- Department of Medical Statistics, School of MedicineTongji UniversityShanghaiChina
- Clinical Research Center for Mental Disorders, Chinese‐German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of MedicineTongji UniversityShanghaiChina
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Le Scodan R, Ghannam Y, Kirova Y, Bourgier C, Richard Tallet A. Radiation therapy of the primary tumour and oligometastatic sites in patients with breast cancer with synchronous metastases: A literature review. Cancer Radiother 2024; 28:3-14. [PMID: 38065784 DOI: 10.1016/j.canrad.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/04/2024]
Abstract
De novo metastatic breast cancer represents 5 to 8% of all breast cancers (2500 new cases per year in France). Systemic treatment is the cornerstone of treatment, whereas radiation therapy usually has a palliative intent. Advances in systemic and local treatments (surgery and radiation therapy) have substantially improved overall survival. In the recent breast cancer statistics in the United States, the 5-year relative survival for patients diagnosed during 2012-2018 was 29% for stage IV (Breast Cancer Statistics). Thus, an increasing proportion of metastatic breast cancers present a prolonged complete response to systemic therapy, which raises the question of the impact of local treatment on patient survival. Radiation therapy has shown its value for early breast cancer, but its place in the local management of the primary tumour or oligometastatic sites for de novo metastatic breast cancer remains under debate. This article is a literature review assessing the role of radiation therapy directed to the primary tumour and oligometastatic sites of breast cancer in patients with synchronous metastases, in order to highlight clinicians in their therapeutic decision.
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Affiliation(s)
- R Le Scodan
- Institut de cancérologie et radiothérapie brétillien (ICRB), hôpitaux privés rennais, centre hospitalier privé Saint-Grégoire, Vivalto, Saint-Grégoire, France.
| | - Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, Angers, France
| | - Y Kirova
- Département de radiothérapie, institut Curie, Paris, France
| | - C Bourgier
- Université de Montpellier, Montpellier, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, institut régional du cancer Montpellier (ICM), Montpellier, France
| | - A Richard Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), Inserm UMR 1068, Marseille, France
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Lucci A, Kim LS, Golshan M, King TA. Great Debate: The Surgeon's Role in Locoregional Management of Stage IV Breast Cancer. Ann Surg Oncol 2023; 30:7000-7007. [PMID: 37596450 DOI: 10.1245/s10434-023-14134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leah S Kim
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mehra Golshan
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Matheka M, Mutebi M, Sayed S, Shah J, Shaikh AJ. Metastatic breast cancer in Kenya: survival, prognosis and management at a tertiary referral centre. Ecancermedicalscience 2023; 17:1566. [PMID: 37396100 PMCID: PMC10310329 DOI: 10.3332/ecancer.2023.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 07/04/2023] Open
Abstract
There has been an increase in breast cancer in Africa with up to 77% of patients diagnosed with advanced disease. However, there is little data on survival outcomes and prognostic factors affecting survival in patients with metastatic breast cancer (MBC) in Africa. The study objective was to establish the survival of patients with MBC at a single tertiary health facility, the clinical and pathological characteristics affecting survival and describe the treatment modalities used. This was a retrospective descriptive study conducted at Aga Khan University Hospital, Nairobi of patients diagnosed with MBC between 2009 and 2017. Survival data was collected on metastatic free survival, survival time between diagnosis of first metastasis and death and overall survival. Data on patient's age, menopausal status and stage at diagnosis, tumour grade, receptor status, site of metastasis and treatment given was also collected. The Kaplan-Meier Estimator was used to estimate survival. Prognostic factors for survival outcomes were analysed using univariate analysis. Standard descriptive statistics were used to describe patient characteristics. A total of 131 patients were included in the study. The median survival was 22 months. The 3 and 5-year survivals were 31.3% and 10.7%, respectively. On univariate analysis, the Luminal A molecular subtype was a significant positive prognostic factor hazard ratios (HR 0.652 95% confidence interval (CI) 0.473-0.899) while metastasis to the liver or brain were significant negative prognostic factors (HR 0.615 95% CI 0.413-0.915 and HR 0.566 95% CI 0.330-0.973, respectively). A large proportion (87.0%) received some treatment for metastatic disease. Our study concluded that survival rates for patients diagnosed with MBC were lower compared to studies from Western countries but higher than in studies from Sub-Saharan Africa. Luminal A molecular subtype was found to be a positive prognostic factor and metastasis to the liver or brain were found to be negative prognostic factors. Improved access to adequate treatment for MBC is required in the region.
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Affiliation(s)
- Mwongeli Matheka
- Aga Khan University Hospital Nairobi, PO Box 30270 - 00100, Nairobi, Kenya
| | - Miriam Mutebi
- Aga Khan University Hospital Nairobi, PO Box 30270 - 00100, Nairobi, Kenya
| | - Shahin Sayed
- Aga Khan University Hospital Nairobi, PO Box 30270 - 00100, Nairobi, Kenya
| | - Jasmit Shah
- Department of Medicine, Aga Khan University, PO Box 30270 - 00100, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, PO Box 30270 - 00100, Nairobi, Kenya
| | - Asim Jamal Shaikh
- Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
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Nie Y, Ying B, Lu Z, Sun T, Sun G. Predicting survival and prognosis of postoperative breast cancer brain metastasis: a population-based retrospective analysis. Chin Med J (Engl) 2023; Publish Ahead of Print:00029330-990000000-00635. [PMID: 37257115 DOI: 10.1097/cm9.0000000000002674] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness. METHODS From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan-Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts. RESULTS LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients (P <0.001). CONCLUSION The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.
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Affiliation(s)
- Yan Nie
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Bicheng Ying
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Zinan Lu
- Xinjiang Cancer Center/Key Laboratory of Oncology of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830011, China
| | - Tonghui Sun
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Gang Sun
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
- Xinjiang Cancer Center/Key Laboratory of Oncology of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830011, China
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Miyashita M, Balogun OB, Olopade OI, Huo D. The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions. Sci Rep 2023; 13:2880. [PMID: 36804591 PMCID: PMC9938892 DOI: 10.1038/s41598-023-29888-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/11/2023] [Indexed: 02/20/2023] Open
Abstract
Prolonged survival of patients with stage IV breast cancer could change the role of radiotherapy for local control of breast primary, but its survival benefit remains unclear. Our aim is to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Stage IV breast cancer patients who received breast surgery and have survived 12 months after diagnosis (landmark analysis) were included in the study from 2010 to 2015 of the National Cancer DataBase. Multivariable Cox models and a propensity score matching were used to control for confounding effects. Of 11,850 patients, 3629 (30.6%) underwent postoperative radiotherapy to breast or chest wall and 8221 (69.4%) did not. In multivariable analysis adjusting for multiple prognostic variables, postoperative radiotherapy was significantly associated with better survival (hazard ratio [HR] 0.74, 95% confidence interval [95%CI] 0.69-0.80; P < 0.001). Radiotherapy was associated with improved survival in patients with bone (P < 0.001) or lung metastasis (P = 0.014), but not in patients with liver (P = 0.549) or brain metastasis (P = 0.407). Radiotherapy was also associated with improved survival in patients with one (P < 0.001) or two metastatic sites (P = 0.028), but not in patients with three or more metastatic sites (P = 0.916). The survival impact of radiotherapy did not differ among subtypes. The results of survival analysis in the propensity score-matched sub-cohort were precisely consistent with those of multivariable analysis. These real-world data show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
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Affiliation(s)
- Minoru Miyashita
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.,Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Onyinye B Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Olufunmilayo I Olopade
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Dezheng Huo
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA. .,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
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12
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Operative Management in Stage IV Breast Cancer. Surg Clin North Am 2023; 103:93-106. [DOI: 10.1016/j.suc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Merloni F, Palleschi M, Gianni C, Casadei C, Curcio A, Romeo A, Rocchi M, Cima S, Sirico M, Sarti S, Cecconetto L, Mariotti M, Di Menna G, De Giorgi U. Locoregional treatment of de novo stage IV breast cancer in the era of modern oncology. Front Oncol 2023; 13:1083297. [PMID: 36793604 PMCID: PMC9923000 DOI: 10.3389/fonc.2023.1083297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
Approximately 6% of metastatic breast cancers arise de novo. While systemic therapy (ST) remains the treatment backbone as for patients with metachronous metastases, locoregional treatment (LRT) of the primary tumor remains a controversial method. The removal of the primary has an established role for palliative purposes, but it is unclear if it could also determine a survival benefit. Retrospective evidence and pre-clinical studies seem to support the removal of the primary as an effective approach to improve survival. On the other hand, most randomized evidence suggests avoiding LRT. Both retrospective and prospective studies suffer several limitations, ranging from selection bias and outdated ST to a small sample of patients. In this review we discuss available data and try to identify subgroups of patients which could benefit the most from LRT of the primary, to facilitate clinical practice decisions, and to hypothesize future studies design on this topic.
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Affiliation(s)
- Filippo Merloni
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Michela Palleschi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Caterina Gianni
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, Pierantoni-Morgagni Hospital Forlì and Santa Maria delle Croci Hospital Ravenna, Forli, Italy
| | - Antonino Romeo
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Maddalena Rocchi
- Breast Surgery Unit, Pierantoni-Morgagni Hospital Forlì and Santa Maria delle Croci Hospital Ravenna, Forli, Italy
| | - Simona Cima
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Marianna Sirico
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Samanta Sarti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Marita Mariotti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Giandomenico Di Menna
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
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14
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Kwong A, Co M, Fukuma E. Prospective Clinical Trial on Expanding Indications for Cryosurgery for Early Breast Cancers. Clin Breast Cancer 2023; 23:363-368. [PMID: 36805386 DOI: 10.1016/j.clbc.2023.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/06/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This is a prospective single arm clinical trial on cryosurgery for early breast cancers, to evaluate the expanded criteria to tumors larger than 1.5 cm and non-luminal breast cancers. METHODS Inclusion criteria include Solitary T1 breast cancers of any immunohistotypes. Cryosurgery was performed using the IceCure ProSense Cryoablation System. Lumpectomy of the cryoablated tumor was then performed 8 weeks after cryosurgery. RESULTS Fifteen patients underwent cryosurgery followed by lumpectomy (BCS). Median age was 53 years old 5 (33.3%) patients had ductal carcinoma in situ (DCIS), while 10 (66.7%) patients had invasive ductal carcinoma (IDC), of which 5 (50%) patients had luminal type cancers of which 3 (60%) were luminal A and 2 (40%) luminal B, 3 (30%) patients had HER2 enriched invasive carcinoma and 2 (20%) patients had triple negative IDC. Median tumor size was 13mm (Range 8.6-18mm). Seven (46.7%) patients were found to have residual cancer in the post-cryosurgery lumpectomy specimen. All residual cancers were found at the periphery of the cryoablated breast tissue. All breast cancers were otherwise completely ablated centrally as confirmed by routine histopathology, immunochemistry and TUNEL assay for evaluation of cell viability. None of the tumor factors such as tumor biology, as well as surgical factors such as ablation time and iceball size, were associated with risk of residual cancer. None of the 15 patients developed post-operative complications. CONCLUSION Residual cancer occurs at the periphery of the cryoablation site, careful pre-operative planning and intra-operative monitoring is crucial to ensure complete cryoablation.
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Affiliation(s)
- Ava Kwong
- Department of Surgery, University of Hong Kong, HKSAR, China.
| | - Michael Co
- Department of Surgery, University of Hong Kong, HKSAR, China
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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Alghamdi MAA, Esam Mahmood S. Role of Surgery in Metastatic Breast Cancer: Insights from a Narrative Review. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:349-358. [PMID: 37192867 PMCID: PMC10182804 DOI: 10.2147/bctt.s405864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
Metastatic breast cancer is difficult to cure and has a worse prognosis with higher rates of mortality. Recently, breast surgery is believed to improve the survival rates among these women, but due to limited evidence, definite conclusions cannot be made. Therefore, we undertook this narrative review to synthesize the evidence from existing studies to assess the effectiveness of locoregional surgery and surgery of metastatic sites in improving the outcomes among women diagnosed with metastatic cancer disease along with the summary of current treatment guidelines. We reviewed PubMed and Embase and included both observational studies and randomized controlled trials (RCTs) that were published in English between 2000 and 2021. Outcomes were either survival, quality of life, toxicity related to local treatment assessed by mortality at the end of one month, progression-free survival, and breast cancer-specific survival. The main effect size assessed was hazard ratio with their 95% CIs. After literature search, we found 8 observational studies and 3 RCTs. The findings of the observational studies revealed that breast cancer surgery improves survival from 30% to 50% among women. However, findings from RCTs were mixed for local and distant progression survival. Surgery improved the local progression-free survival but worsened the distant progression-free survival. Besides, there was no effect of breast surgery on quality of life. Regarding the surgery of metastatic site, studies are complex with mixed findings and variation in survival depending upon the type of metastatic site and response to initial systematic therapy and other factors. Based on the existing mixed evidence, it is not possible to make firm and definite conclusions about the effectiveness of breast surgery in improving the survival or quality of life among women with metastatic breast cancer. In future, more RCTs are required with a larger sample size to confirm the findings of observational studies.
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Affiliation(s)
| | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Correspondence: Syed Esam Mahmood, Abha, 62529, Saudi Arabia, Tel +966550484344, Email
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16
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Hotton J, Lusque A, Leufflen L, Campone M, Levy C, Honart JF, Mailliez A, Debled M, Gutowski M, Leheurteur M, Goncalves A, Jankowski C, Guillermet S, Bachelot T, Ferrero JM, Eymard JC, Petit T, Pouget N, de La Lande B, Frenel JS, Villacroux O, Simon G, Pons-Tostivint E, Marchai F. Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort. Ann Surg 2023; 277:e153-e161. [PMID: 33534229 DOI: 10.1097/sla.0000000000004767] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to evaluate the impact of local surgery performed during the year after MBC diagnosis on patients' outcomes from a large reallife cohort. SUMMARY BACKGROUND DATA Locoregional treatment for patients with MBC at the time of diagnosis remains debated. METHODS Women with newly diagnosed, de novo stage IV MBC and who started MBC treatment between January 2008 and December 2014 in one of the 18 French Comprehensive Cancer Centers were included (NCT03275311). The impact of local surgery performed during the first year on overall survival (OS) and progression-free survival (PFS) was evaluated by the Cox proportional hazards model in a 12 month-landmark analysis. RESULTS Out of 16,703 patients in the ESME database, 1977 had stage IV MBC at diagnosis, were alive and progression-free at 12 months and eligible for this study. Among them, 530 (26.8%) had received primary breast cancer surgery within 12 months. A greater proportion of patients who received surgery had less than 3 metastatic sites than the no-surgery group (90.8% vs 78.2%, P < 0.0001). Surgery within 12 months was associated with treatment with chemotherapy, HER2-targeted therapy (89.1% vs 69.6%, P < 0.0001) and locoregional radiotherapy (81.7% vs 32.5%, P < 0.0001). Multivariable analyses showed that surgery performed within 12 months was associated with longer OS and PFS (adjusted HR [95%CI] = 0.75 [0.61-0.92] and 0.72 [0.63-0.83], respectively), which were also affected by pattern and number of metastatic sites, histological subtype, and age. CONCLUSIONS In the large ESME cohort, surgery within 1 year after de novo MBC diagnosis was associated with a significantly better OS and PFS.
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Affiliation(s)
- Judicaël Hotton
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
- Department of Surgical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irene-Joliot-Curie, 31059 Toulouse, France
| | - Léa Leufflen
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes & Angers, 15 rue Andre Boquel, 49055 Angers, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de l'Argonne, F-33000 Bordeaux, France
| | - Marian Gutowski
- Department of Surgical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille
| | - Clementine Jankowski
- Department of Surgical Oncology, Centre Georges Francois Leclerc, 1 rue Professeur Marion, 21079 Dijon, France
| | - Sophie Guillermet
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Thomas Bachelot
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacas-sagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Jean-Christophe Eymard
- Department of Medical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l,Hopital, 67000 Strasbourg, France
| | - Nicolas Pouget
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Brigitte de La Lande
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l,Ouest - Rene Gauducheau, Boulevard Professeur Jacques Monod, 44805 Nantes, France
| | - Olivier Villacroux
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Gaëtane Simon
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Elvire Pons-Tostivint
- Department of Medical Oncology, Centre Leon Berard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irtine-Joliot-Curie, 31059 Toulouse, France
| | - Frédéric Marchai
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Loco-Regional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancer Patients Undergoing Front-Line Chemotherapy. Cancers (Basel) 2022; 14:cancers14246237. [PMID: 36551722 PMCID: PMC9777012 DOI: 10.3390/cancers14246237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Loco-regional therapy (LRT) in de novo metastatic breast cancer (MBC) has been investigated in several clinical trials, with heterogeneous and conflicting results. METHODS We conducted a retrospective study of de novo MBC patients treated with front-line chemotherapy (FLC) followed by LRT of the primary tumor. Our aims were to evaluate the characteristics, treatment, and oncological outcomes in terms of progression-free survival (PFS), distant progression-free survival (DPFS), and overall survival (OS) of de novo MBC. We also investigated possible subgroups of patients with better outcomes according to menopausal status, biological sub-type, location, number of metastases, and radiologic complete response after FLC. RESULTS We included 61 patients in the study. After a median follow-up of 55 months, disease progression occurred in 60.7% of patients and 49.2% died. There were no significant differences in PFS, DPFS, and OS between different subgroups of de novo MBC patients. A trend toward better PFS and DPFS was observed in triple-positive tumors, without a statistically significant difference in OS. CONCLUSIONS No specific subgroup of de novo MBC patients showed a statistically significant survival advantage after FLC followed by LRT of the primary tumor.
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Yadav BS, Sunku R, Dahiya D. Impact of loco-regional treatment including radiotherapy in patients presenting with metastatic breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022; 21:466-471. [DOI: 10.1017/s1460396921000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:The impact of loco-regional treatment (LRT) with radiotherapy (RT) in patients presenting with metastatic breast cancer (MBC) has not been widely studied. The aim of this study was to review the treatment outcomes of LRT including RT in patients with MBC.Materials and methods:Patients who presented with MBC were included in this retrospective study. Analysis was undertaken to determine the difference in local disease control, overall survival (OS) and progression-free survival (PFS) with systemic treatment alone, surgery alone, surgery plus RT and RT alone with long-rank test. Multivariate analysis was done, using the cox regression for factors affecting PFS and OS.Results:From 2007 to 2014, data of 257 patients with MBC were collected. Totally, 185 patients received LRT and 72 did not. LRT was surgery plus RT, surgery only and RT only in 113, 47 and 25 patients, respectively. Cytotoxic chemotherapy and hormone therapy were received by 205 and 166 patients, respectively. Median follow-up was 36 months (6–120 months). PFS and OS at 3 years with and without LRT were 31% versus 6% (p < 0·001) and 41% versus 17% (p < 0·001), respectively. PFS at 3 years with surgery plus RT, RT alone and surgery was 40, 33 and 6%, respectively. OS at 3 years with surgery plus RT, RT alone and surgery was 50, 38 and 17%, respectively. Patients without LRT had worse PFS and OS, 6 and 17%, respectively. RT had significant impact on PFS and OS along with chemotherapy and hormone treatment.Conclusion:In patients with MBC, improved local control, PFS and OS were achieved with loco-regional RT. Loco-regional RT along with chemotherapy and hormones were significant factors for PFS and OS irrespective of surgery.
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Ghannam Y, Laville A, Kirova Y, Latorzeff I, Levy A, Zhou Y, Bourbonne V. Radiotherapy of the Primary Disease for Synchronous Metastatic Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235929. [PMID: 36497410 PMCID: PMC9736289 DOI: 10.3390/cancers14235929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
In the case of synchronous metastatic disease, the local treatment of primary tumors by radiotherapy has long been reserved for palliative indications. The emergence of the concept of oligometastatic and oligopersistent diseases, the advent of new systemic therapies enabling longer overall survival with an enhanced quality of life, a better understanding of the biologic history of metastatic spread, and technical advances in radiation therapy are revolutionizing the management of patients with de novo metastatic cancer. The prognosis of these patients has been markedly improved and many studies have investigated the survival benefits from the local treatment of various primary tumors in cases of advanced disease at the time of diagnosis or in the case of oligopersistence. This article provides an update on the place of irradiation of the primary tumor in cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Youssef Ghannam
- Radiation Oncology Department, Centre Paul Papin, Institut de Cancérologie de l’Ouest, 49055 Angers, France
- Correspondence: (Y.G.); (V.B.)
| | - Adrien Laville
- Radiation Oncology Department, CHU Amiens-Picardie, 80000 Amiens, France
| | - Youlia Kirova
- Radiation Oncology Department, Institut Curie Paris, CEDEX 05, 75248 Paris, France
| | - Igor Latorzeff
- Radiation Oncology Department, Bât Atrium Clinique Pasteur, 31300 Toulouse, France
| | - Antonin Levy
- Radiation Oncology Department, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Yuedan Zhou
- Radiation Oncology Department, CHU Amiens-Picardie, 80000 Amiens, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- Correspondence: (Y.G.); (V.B.)
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Khan SA, Schuetz S, Hosseini O. Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol 2022; 29:5811-5820. [PMID: 35608802 DOI: 10.1245/s10434-022-11900-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Until 2001, the paradigm guiding the management of women with de novo metastatic breast cancer (dnMBC) stipulated that primary-site locoregional therapy (PSLT) did not alter the course of metastatic disease and was necessary only for palliation of symptoms. Since 2002, retrospective data have begun questioning this paradigm. However, selection biases driving an observed survival advantage associated with PSLT in dnMBC were quickly recognized and led to several randomized clinical trials (RCTs) addressing this question. METHODS AND RESULTS Four published RCTs have since tested the value of PSLT added to systemic therapy (ST) or not, with overall survival (OS) as the primary end point. The results of three published trials show no OS benefit for the addition of PSLT: Indian Tata Memorial, U.S./Canada E2108, and Austrian POSYTIVE (although POSYTIVE did not reach full accrual). The fourth RCT (Turkey, MF07-01) shows an OS benefit for PSLT at 5 years (42 % vs 24 % in the ST arm; hazard ratio [HR], 0.66; 95 % confidence interval [CI], 0.49-0.88). However, the 5-year survival in the PSLT arm of MF07-01 is similar to that in both arms of E2108, suggesting that the worse survival in the ST arm of MF07-01 is a result of biologically worse disease (from imbalanced randomization). Locoregional control was improved by PSLT in all trials, but without improvement in quality of life. CONCLUSIONS The current evidence fails to refute the 20th century paradigm guiding management of de novo metastatic breast cancer. Discussion continues regarding the survival value of PSLT for patients with bone-only disease or oligometastases, but unbiased evidence is lacking.
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Affiliation(s)
- Seema Ahsan Khan
- Department of Surgery, Feinberg School of Medicine of Northwestern University, 303 East Superior Street, Lurie 4-111, Chicago, IL, 60611, USA.
| | - Steven Schuetz
- Department of Surgery, Feinberg School of Medicine of Northwestern University, 303 East Superior Street, Lurie 4-111, Chicago, IL, 60611, USA
| | - Omid Hosseini
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
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21
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Exploring the Value of Additional Primary Tumour Excision Combined with Systemic Therapy Administered in Different Sequences for Patients with de Novo Metastatic Breast Cancer. Breast J 2022; 2022:5049445. [PMID: 36082023 PMCID: PMC9436631 DOI: 10.1155/2022/5049445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
Abstract
Introduction Uncertainty still remains regarding the survival improvement derived from immediate surgery or subsequent surgery in addition to systemic therapy for patients with de novo metastatic breast cancer. The current study aimed to examine the effect of combined treatment administered in different sequences on the survival of these patients. Materials and Methods We conducted a retrospective cohort study of patients with de novo stage IV breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. Patients were categorized into 3 groups: (1) systemic therapy without primary surgery, (2) systemic therapy after primary surgery, and (3) systemic therapy before primary surgery. Cumulative incidence curves with Gray's test were used to compare breast cancer-specific death (BCSD) between groups. Kaplan–Meier curves with the log-rank test were applied to compare overall survival (OS) between groups. A competing risk model and a proportional hazards model were generated to adjust for important prognostic factors. Propensity score matching (PSM) was performed in the primary survival analysis. Stratified analysis was also performed. Results Patients who underwent systemic therapy after primary surgery and who underwent systemic therapy before primary surgery both showed a significantly reduced risk of BCSD compared to patients who received systemic therapy without primary surgery [subdistribution hazard ratio (SHR): 0.74; 95% confidence interval (CI): 0.69–0.79; and P < 0.001, and SHR: 0.62; 95% CI: 0.56–0.67; and P < 0.001, respectively]. A statistically significant disparity was also noted in OS. In the setting of single-organ metastasis, including the bone, lung, and liver, patients receiving the combination therapy showed an improved prognosis compared with patients receiving systemic therapy without primary surgery. Conclusions Additional primary tumour excision, whether before or after systemic therapy, may provide survival benefits for patients presenting with de novo metastatic breast cancer, especially for patients with single-organ disease involving the bone, lung, and liver but not the brain. Further investigations mainly focused on these carefully selected candidates are required to improve personalized treatment for metastatic breast cancer.
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22
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Zhu A, Yun Z, You M, Liu X, Liang X, Yan Y, Shao B, Jiang H, Di L, Song G, Li H. Surgical reduction in chest wall disease to prolong survival in breast cancer patients: a retrospective study. Gland Surg 2022; 11:1015-1025. [PMID: 35800744 PMCID: PMC9253183 DOI: 10.21037/gs-22-246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 01/10/2024]
Abstract
Background Patients with breast cancer (BC) may develop locoregional recurrence alone or with distant metastases. Results of previous studies discussing the benefit of local surgery among patients with chest wall disease were controversial. Whether surgical reduction for chest wall disease could influence survival outcome is still a question. The objective of this study was to compare overall survival (OS) in patients with recurrence involving the chest wall who did or did not undergo surgical reduction after previous treatment of the primary BC to explore the role of surgical reduction. Methods We retrospectively reviewed BC patients with chest wall as the first recurrent/metastatic site selected between January 2012 and December 2018 to explore whether surgical reduction for chest wall disease could influence OS. Clinicopathological data, including age at initial diagnosis, TNM stage, the pathological parameters, and treatment were recorded and analyzed. OS was primarily described using the Kaplan-Meier estimator for each group, with the statistical significance between groups being tested by the log-rank test. Results A total of 198 patients with a median age of 48 years (range, 22-73 years) were analyzed. Chest wall as the only site of recurrence occurred in 139 patients (70.2%), and the other 59 (29.8%) patients had other metastatic sites. There were 88 patients who underwent surgical reduction for chest wall recurrence. The median OS was significantly longer for the patients who had chest wall disease reduction than for those who did not {194.2 months [95% confidence interval (CI): 140.4-247.9 months] vs. 102.7 months (95% CI: 79.7-125.7 months), respectively, P=0.001}. From multivariate analysis, surgical reduction was an independent factor significantly influenced OS (HR =0.52, 95% CI: 0.33-0.81, P=0.004). Subgroup analyses showed that OS was statistically longer in the chest wall disease surgical reduction group than in the no reduction group with respect to hormone receptor (HR) negative (-), human epidermal growth factor receptor 2 (HER2) negative (-), triple-negative breast cancer (TNBC), disease-free survival (DFS) >24 months, and chest wall disease only. Conclusions BC patients with chest wall recurrence could benefit from surgical reduction with a prolonged OS. In a certain selected group, surgical reduction may be warranted.
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Affiliation(s)
- Anjie Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zehui Yun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miaoning You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Shao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijun Di
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Plichta JK, Thomas SM, Sergesketter AR, Greenup RA, Rosenberger LH, Fayanju OM, Kimmick G, Force J, Hyslop T, Hwang ES. A Novel Staging System for De Novo Metastatic Breast Cancer Refines Prognostic Estimates. Ann Surg 2022; 275:784-792. [PMID: 32657941 PMCID: PMC7794098 DOI: 10.1097/sla.0000000000004231] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aim to identify prognostic groups within a de novo metastatic cohort, incorporating both anatomic and biologic factors. BACKGROUND Staging for breast cancer now includes anatomic and biologic factors, although the guidelines for stage IV disease do not account for how these factors may influence outcomes. METHODS Adults with de novo metastatic breast cancer were selected from the National Cancer DataBase (2010-2013). Recursive partitioning analysis was used to group patients with similar overall survival (OS) based on clinical T/N stage, tumor grade, ER, PR, HER2, number of metastatic sites, and presence of bone-only metastases. Categories were created by amalgamating homogeneous groups based on 3-year OS rates (stage IVA: >50%, stage IVB: 30%-50%, stage IVC: <30%). RESULTS 16,187 patients were identified; median follow-up was 32 months. 65.2% had 1 site of distant metastasis, and 42.9% had bone-only metastases. Recursive partitioning analysis identified the number of metastatic sites (1 vs >1) as the first stratification point, and ER status as the second stratification point for both resulting groups. Additional divisions were made based on HER2 status, PR status, cT stage, tumor grade, and presence of bone-only metastases. After bootstrapping, significant differences in 3-year OS were noted between the 3 groups [stage IVB vs IVA: HR 1.58 (95% confidence interval 1.50-1.67), stage IVC vs IVA: HR 3.54 (95% confidence interval 3.33-3.77)]. CONCLUSIONS Both anatomic and biologic factors yielded reliable and reproducible prognostic estimates among patients with metastatic disease. These findings support formal stratification of de novo stage IV breast cancer into 3 distinct prognosis groups.
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Affiliation(s)
- Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Samantha M. Thomas
- Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | | | - Rachel A. Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Gretchen Kimmick
- Duke Cancer Institute, Durham, North Carolina
- Department of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jeremy Force
- Duke Cancer Institute, Durham, North Carolina
- Department of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Khan SA, Zhao F, Goldstein LJ, Cella D, Basik M, Golshan M, Julian TB, Pockaj BA, Lee CA, Razaq W, Sparano JA, Babiera GV, Dy IA, Jain S, Silverman P, Fisher CS, Tevaarwerk AJ, Wagner LI, Sledge GW. Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (EA2108). J Clin Oncol 2022; 40:978-987. [PMID: 34995128 PMCID: PMC8937009 DOI: 10.1200/jco.21.02006] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/01/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Distant metastases are present in 6% or more of patients with newly diagnosed breast cancer. In this context, locoregional therapy for the intact primary tumor has been hypothesized to improve overall survival (OS), but clinical trials have reported conflicting results. METHODS Women presenting with metastatic breast cancer and an intact primary tumor received systemic therapy for 4-8 months; if no disease progression occurred, they were randomly assigned to locoregional therapy for the primary site (surgery and radiotherapy per standards for nonmetastatic disease) or continuing sysmetic therapy. The primary end point was OS; locoregional control and quality of life were secondary end points. The trial design provided 85% power to detect a 19.3% absolute difference in the 3-year OS rate in randomly assigned patients. The stratified log-rank test and Cox proportional hazards model were used to compare OS between arms. Cumulative incidence of locoregional progression was compared using Gray's test. Quality-of-life assessment used standard instruments. RESULTS Of 390 participants enrolled, 256 were randomly assigned: 131 to continued systemic therapy and 125 to early locoregional therapy. The 3-year OS was 67.9% without and 68.4% with early locoregional therapy (hazard ratio = 1.11; 90% CI, 0.82 to 1.52; P = .57). The median OS was 53.1 months (95% CI, 47.9 to not estimable) in the systemic therapy arm and 54.9 months (95% CI, 46.7 to not estimable) in the locoregional therapy arm. Locoregional progression was less frequent in those randomly assigned to locoregional therapy (3-year rate: 16.3% v 39.8%; P < .001). Quality-of-life measures were largely similar between arms. CONCLUSION Early locoregional therapy for the primary site did not improve survival in patients presenting with metastatic breast cancer. Although it was associated with improved locoregional control, this had no overall impact on quality of life.
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Affiliation(s)
| | - Fengmin Zhao
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Mark Basik
- Jewish General Hospital Lady Davis Institute, McGill University, Montréal, QC, Canada
| | - Mehra Golshan
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | | | | | | | - Wajeeha Razaq
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Irene A. Dy
- Eisenhower Medical Center, Rancho Mirage, CA
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25
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Anderson DN, Port ER. Surgery No More? Managing the Primary Tumor in Stage IV Breast Cancer. J Clin Oncol 2022; 40:927-931. [PMID: 35119913 DOI: 10.1200/jco.21.02706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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26
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Díaz-Casas SE, Briceño-Morales X, Puerto-Horta LJ, Lehmann-Mosquera C, Orozco-Ospino MC, Guzmán-AbiSaab LH, Ángel-Aristizábal J, García-Mora M, Duarte-Torres CA, Mariño-Lozano IF, Briceño-Morales C, Sánchez-Pedraza R. OUP accepted manuscript. Oncologist 2022; 27:e142-e150. [PMID: 35641213 PMCID: PMC8895754 DOI: 10.1093/oncolo/oyab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose About 10% of breast cancer (BC) is diagnosed in stage IV. This study sought to identify factors associated with time to progression (TTP) and overall survival (OS) in a cohort of patients diagnosed with de novo metastatic breast cancer (MBC), from a single cancer center in Colombia, given that information on this aspect is limited. Methodology An observational, analytical, and retrospective cohort study was carried out. Time to progression and OS rates were estimated using the Kaplan–Meier survival functions. Cox models were developed to assess association between time to progression and time to death, using a group of fixed variables. Results Overall, 175 patients were included in the study; 33.7% of patients had luminal B HER2-negative tumors, 49.7% had bone involvement, and 83.4% had multiple metastatic sites. Tumor biology and primary tumor surgery were the variables associated with TTP and OS. Patients with luminal A tumors had the lowest progression and mortality rates (10 per 100 patients/year (95% CI: 5.0-20.0) and 12.6 per 100 patients/year (95% CI: 6.9-22.7), respectively), and patients with triple-negative tumors had the highest progression and mortality rates (40 per 100 patients/year (95% CI: 23.2-68.8) and 44.1 per 100 patients/year (95% CI: 28.1-69.1), respectively). Across the cohort, the median TTP was 2.1 years (95% CI: 1.6; the upper limit cannot be reached) and the median OS was 2.4 years (95% CI: 2-4.3). Conclusions In this cohort, patients with luminal A tumors and those who underwent tumor surgery given that they presented clinical benefit (CB) after initial systemic treatment, had the lowest progression and mortality rates. Overall, OS was inferior to other series due to high tumor burden and difficulties in accessing and continuing oncological treatments.
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Affiliation(s)
- Sandra Esperanza Díaz-Casas
- Breast Unit, National Cancer Institute of Colombia, Bogotá, Colombia
- Corresponding author: Sandra Esperanza Díaz-Casas, Breast and Soft Tissue Unit, National Cancer Institute, Calle 1A #9-85, Bogotá, DC 110321, Colombia. Tel: +57 310 819 7384;
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27
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Jianna S, Lingjun K, Nana F, Hong L, Chongxi R. Locoregional Therapy in De novo Metastatic Breast Cancer: A Retrospective Cohort Study. Technol Cancer Res Treat 2022; 21:15330338221115356. [PMID: 35899318 PMCID: PMC9340403 DOI: 10.1177/15330338221115356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Whether locoregional therapy (LRT) should be performed in patients with de novo metastatic breast cancer (dnMBC) has been debated. Here we report the survival outcomes of LRT in patients with dnMBC, focusing on the association of surgical timings and surgical margins with survival in this patient population. Methods: The retrospective study included patients with dnMBC in our hospital, between March 1, 2007 and December 31, 2017. Overall survival (OS) was evaluated by means of a stratified log-rank test and summarized with the use of Kaplan-Meier methods. Results: A total of 153 patients were included, of whom 87 underwent LRT and 66 systemic therapy alone (STA). LRT showed a significant OS benefit over STA (HR, 0.62; 95% CI, 0.39 to 0.99; P = .043). The OS of LRT group and STA group were 39 months (95% CI, 33.6 to 44.4 months) and 24.6 months (95% CI, 20.6 to 28.6 months), respectively. The benefit was consistent across most subgroups. The OS of patients undergoing surgery was better than that of patients without surgery (HR, 0.58; 95% CI, 0.35 to 0.94; P = .0001), and there was difference in survival improvement at different surgical timings (surgery before chemotherapy, during chemotherapy, and after chemotherapy) (P = .0001). The survival benefit of surgery after chemotherapy was significantly greater than that of the other 2 options (HR, 0.77; 95% CI, 0.63 to 0.94). Moreover, compared with patients with positive margins, the OS of patients with negative margins was significantly improved (HR, 0.22; 95% CI, 0.13 to 0.37; P < .001). Conclusions: Our results suggest that LRT is associated with improved OS in women with dnMBC, and patients who had surgery after systemic chemotherapy with negative surgical margins, are expected to benefit more.
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Affiliation(s)
- Sun Jianna
- Cangzhou Clinical College of Integrated Traditional Chinese and
Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Kong Lingjun
- Cangzhou Clinical College of Integrated Traditional Chinese and
Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Feng Nana
- Cangzhou Clinical College of Integrated Traditional Chinese and
Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Liu Hong
- Tianjin Medical University Cancer
Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Ren Chongxi
- Cangzhou Clinical College of Integrated Traditional Chinese and
Western Medicine of Hebei Medical University, Cang Zhou, China
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28
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Peng P, Chen JY, Han YT, Chen X, Li HY, Hu CH, Wang JL. Impact of surgery on survival in breast cancer with bone metastases only: a SEER database retrospective analysis. BMC Surg 2021; 21:378. [PMID: 34702227 PMCID: PMC8549185 DOI: 10.1186/s12893-021-01378-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It was controversial to operate on the primary site of breast cancer (BC) with bone metastasis only. We investigated the impact of surgery on BC patients with bone metastases via a SEER database retrospective analysis. METHODS A total of 2917 BC cases with bone metastasis, first diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and Results Database (SEER) of National Cancer Institute were selected. We assessed the effect of different surgical procedures on survival and prognosis. RESULTS Compared with the non-surgical group, the primary tumor surgical group showed longer median survival time (χ2 = 146.023, P < 0.001), and the breast-conserving subgroup showed the highest median survival time of 70 months (χ2 = 157.117, P < 0.001). Compared with the non-surgery group, the median overall survival (OS) of primary surgery group was longer (HR = 0.525, 95%CI = 0.467-0.590, P < 0.001), and the breast-conserving subgroup showed the longest median operative OS (HR = 0.394, 95%CI = 0.325-0.478, P < 0.001). CONCLUSION This study showed that primary surgery could improve the median survival time and OS of BC patients with bone metastasis. Moreover, under the condition of low tumor burden, breast conserving surgery was a better choice.
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Affiliation(s)
- Pai Peng
- Department of Breast and Thyroid Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Square Road No. 6 Xiaogan, Hubei, China
| | - Jiang-Yuan Chen
- School of Medicine, Jianghan University, 8 Xuefu Road, Wuhan Economic and Technological Development Zone, Wuhan, Hubei, China.
| | - Yun-Tao Han
- Department of Breast and Thyroid Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Square Road No. 6 Xiaogan, Hubei, China
| | - Xin Chen
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong, Chongqing, China
| | - Hong-Yuan Li
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong, Chongqing, China
| | - Chao-Hua Hu
- Department of Breast and Thyroid Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Square Road No. 6 Xiaogan, Hubei, China.
| | - Jin-Li Wang
- Department of Breast Surgery, Jingzhou Central Hospital, No. 60 Jingjing Road, Jingzhou, Jingzhou, Hubei, China
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29
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Çöpelci Y, Gündüz UR, Dinç B, Belen NH, Gündüz Ş. Effects of Primary Tumor Resection on Metastatic Breast Cancer Survival and the Predictive Power of Neutrophil: Lymphocyte Ratio on Prognosis. Eur J Breast Health 2021; 17:322-327. [PMID: 34651110 DOI: 10.4274/ejbh.galenos.2021.2021-3-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 12/01/2022]
Abstract
Objective The aim was to investigate the effect of primary tumor resection (PTR) on survival in metastatic breast cancer patients and to assess the power of the neutrophil-to-lymphocyte ratio (NLR) regarding the prediction of prognosis in this patient group. Materials and Methods Female patients diagnosed with and starting treatment for metastatic breast cancer from 2003 to 2016 in the general surgery and oncology clinics at a single center were retrospectively reviewed. Pre-treatment NLR value and survival situations were evaluated. Results A total of 117 patients were enrolled. The disease-specific survival (DSS) of the patients was 41.4 months. When stratified into PTR and systemic treatment (ST) groups, there was no difference in the survival (p = 0.054); 43.5 months in the PTR group vs 30.7 months in the ST group. When hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative subgroups were analyzed, DSS was significantly longer (p = 0.02) in the PTR group (55.4 months) compared to the ST group (41.8 months). Finally, in patients with an NLR of <2.3, DSS was significantly longer (p = 0.03) in the PTR group (56.1 months) compared to the ST group (25.2 months). Conclusion These results suggest that DSS can be increased with PTR in selected patients with a diagnosis of metastatic breast cancer. NLR may be useful in selecting patients for appropraite treatment modality.
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Affiliation(s)
- Yaşar Çöpelci
- Department of General Surgery, University of Health Sciences Turkey, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Umut Rıza Gündüz
- Department of General Surgery, University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Turkey
| | - Bülent Dinç
- Department of General Surgery, University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nurhan Haluk Belen
- Department of General Surgery, University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Turkey
| | - Şeyda Gündüz
- Clinic of Medical Oncology, Memorial Antalya Hospital, Antalya, Turkey
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30
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Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk NZ, Utkan Z, Evrensel T, Sezgin E. Primary Surgery with Systemic Therapy in Patients with de Novo Stage IV Breast Cancer: 10-year Follow-up; Protocol MF07-01 Randomized Clinical Trial. J Am Coll Surg 2021; 233:742-751.e5. [PMID: 34530124 DOI: 10.1016/j.jamcollsurg.2021.08.686] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this randomized clinical trial was to evaluate the overall survival (OS) data of patients diagnosed with de novo stage IV breast cancer (BC) who received locoregional treatment (LRT) over a 10-year follow-up. STUDY DESIGN The MF07-01 is a 1:1 multicenter, randomized clinical trial comparing the LRT with systemic therapy (ST), where ST was given to all patients either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS A total of 278 patients were randomized and 265 patients were in the final analysis. At 10-year follow-up, survivals were 19% (95% CI 13%-28%) and 5% (95% CI 2%-12%) in the LRT group and ST group, respectively. Median survival was 46 months for the LRT group and 35 months for the ST group, and hazard of death was 29% lower in the LRT group compared with the ST group (hazard ratio [HR] 0.71; 95% CI 0.59-0.86; p = 0.0003). CONCLUSIONS Patients with a diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 14% higher chance of OS by the end of the 10-year follow-up compared with the patients who received only ST. The longer study follow-up revealed that LRT should be presented to patients when discussing treatment options.
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Affiliation(s)
- Atilla Soran
- Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA.
| | - Vahit Ozmen
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Capa, Istanbul, Turkey
| | | | - Abdullah Igci
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Zafer Utkan
- Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Uludag University School of Medicine, Bursa, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey
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Yu Y, Hong H, Wang Y, Fu T, Chen Y, Zhao J, Chen P, Cai R, Tan Y, He Z, Ren W, Zhou L, Huang J, Tang J, Ye G, Yao H. Clinical Evidence for Locoregional Surgery of the Primary Tumor in Patients with De Novo Stage IV Breast Cancer. Ann Surg Oncol 2021; 28:5059-5070. [PMID: 33534046 DOI: 10.1245/s10434-021-09650-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Whether primary tumor surgery is better than no surgery in patients with de novo stage IV breast cancer remains controversial. METHODS This study combined prospective clinical trials and a multicenter cohort to evaluate the impact of locoregional surgery in de novo stage IV breast cancer. The GRADE approach was used to assess the quality of evidence in meta-analysis, and propensity score matching analysis was used in the cohort study. This study was registered with PROSPERO CRD42016043766 and ClinicalTrials.gov NCT04456855. RESULTS A total of 1110 patients from six trials and 353 patients from the cohort study were included. The meta-analysis showed that compared with no surgery, locoregional surgery did not prolong overall survival (hazard ratio [HR] = 0.90, P = 0.40; moderate-quality) but had a significantly longer locoregional progression-free survival (HR = 0.23, P < 0.001; moderate-quality). The subgroup analysis of solitary bone-only metastasis (HR = 0.47, P = 0.04; high-quality) resulted in prolonged overall survival. In the cohort study, locoregional surgery showed a survival benefit (HR = 0.63, P = 0.041) before matching, but not (HR = 0.84, P = 0.579) after matching. Patients with bone-only metastasis showed a survival advantage in surgery compared with no surgery before matching (HR = 0.36, P = 0.034) as well as after matching (HR = 0.18, P = 0.017). CONCLUSIONS This study indicated that locoregional surgery had a significantly longer locoregional progression-free survival than no surgery in de novo stage IV breast cancer, and patients with bone-only metastasis tended to show an overall survival benefit from surgery.
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Affiliation(s)
- Yunfang Yu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huangming Hong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tuping Fu
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yongjian Chen
- Department of Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianli Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peixian Chen
- Department of Breast Surgery, The First People's Hospital of Foshan, Fosan Afflicted Hospital of Sun Yat-sen University, Foshan, China
| | - Ruizhao Cai
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yujie Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zifan He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ren
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lihuan Zhou
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Junhao Huang
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun Tang
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Guolin Ye
- Department of Breast Surgery, The First People's Hospital of Foshan, Fosan Afflicted Hospital of Sun Yat-sen University, Foshan, China.
| | - Herui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Soran A, Soyder A, Ozbas S, Ozmen V, Karanlik H, Igci A, Muslumanoglu M, Evrensel T, Canturk Z, Utkan Z, Ozaslan C, Uras C, Ugurlu U, Col C, Cabioglu N, Uzunkoy A, Gulluoglu BM, Erdem E, Konca C, Sezgin E. The role of loco-regional treatment in long-term quality of life in de novo stage IV breast cancer patients: protocol MF07-01Q. Support Care Cancer 2021; 29:3823-3830. [PMID: 33242163 DOI: 10.1007/s00520-020-05905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND/OBJECTIVE Since more solid evidence has emerged supporting the effectiveness of loco-regional treatment (LRT), clinicians consider LRT a treatment option for selected de novo stage IV breast cancer (BC) patients. This is the first report on long-term quality of life (QoL) in a cohort of patients who were randomized to receive either LRT and then systemic treatment (ST) or ST alone in the protocol MF07-01. We aimed to evaluate QoL in patients living at least 3 years since randomization using scores from the SF-12 health survey. METHODS SF-12 (V2) forms were completed during visits of patients who were living 36 months after the randomization. We first calculated PCS-12 (Physical Health Composite Scale) and MCS-12 (Mental Health Composite Scale) scores from de novo stage IV BC patients and compared them with the scores of patients diagnosed with stage I-III BC who lived more than 3 years. Further, PCS-12 and MCS-12 scores were compared between the LRT and ST groups with de novo stage IV BC. Additionally, general health, physical functioning, role functioning, bodily pain, vitality, mental health, and social functioning were evaluated and compared between the groups. Considering age-related changes in QoL, we also compared PCS-12 and MCS-12 scores of patients below or above 55 and 65 years of age. Responses to four additional questions (compare your physical health, mental health, daily activities, and energy currently vs. at diagnosis of BC) were recorded, considering cultural differences. RESULTS There were 81 patients in this analysis; 68% of patients (n = 55) had LRT, and 32% (n = 26) received ST. General health was good or very good in 62% (n = 34) in the LRT group and 66% (n = 17) in the ST-only group (p = 0.63). Mean PCS-12 score was 40.8 + 1.6, and mean MCS-12 score was 43.4 + 2.0 (p = 0.34 and p = 0.54, respectively). PCS-12 and MCS-12 score difference was lower than that of the general Turkish population (PCS-12 = 49.3 + 12.8 and MCS-12 = 46.8 + 13.0) and stage I-III BC patients (PCS-12 = 51.1 ± 0.5, MCS-12 = 45.7 ± 0.6). PCS-12 and MCS-12 scores were similar between the LRT and ST-only groups in patients younger and older than 55 and 65, but QoL scores were much better in stage I-III BC patients younger than 65 when compared to the scores of those with de novo stage IV BC. Although treatment with or without LRT did not affect physical health, mental health, daily activities, and energy at 3 years vs. at diagnosis of BC in de novo stage IV BC patients (p > 0.05), these variables were significantly better in stage I-III BC patients (p < 0.001). CONCLUSION The current MF07-01Q study demonstrates that patient who had LRT has similar physical and mental health outcomes compared to ST only in a cohort of patients who lived longer than 3 years. Trial registration This study is registered on clinicaltrials.gov with identifier number NCT00557986.
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Affiliation(s)
- Atilla Soran
- Surgical Oncology, University of Pittsburgh, 300 Halket St Suite 2601, Pittsburgh, PA, 15213, USA.
- Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - Aykut Soyder
- Department of Surgery, Acibadem Altunizade Hospital, İstanbul, Turkey
| | - Serdar Ozbas
- Breast and Endocrine Surgeon, Private Practice, Ankara, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Capa, Istanbul, Turkey
| | - Abdullah Igci
- Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Uludag University School of Medicine, Bursa, Turkey
| | - Zafer Canturk
- Department of Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Zafer Utkan
- Department of Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Cihangir Ozaslan
- Department of Surgery, Ankara Oncology Teaching and Research Hospital, Ankara, Turkey
| | - Cihan Uras
- Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Umit Ugurlu
- Department of Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Cavit Col
- Department of Surgery, Etimed Hospital, Etimesgut, Ankara, Turkey
| | - Neslihan Cabioglu
- Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Uzunkoy
- Department of Surgery, Harran University School of Medicine, Sanlıurfa, Turkey
| | - Bahadır M Gulluoglu
- Department of Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ergun Erdem
- Department of Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Can Konca
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey
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Patel G, Kishore Reddy BV, Patil P. Is Surgical Management of Primary Beneficial in Metastatic Breast Cancer?? Indian J Surg Oncol 2021; 12:421-427. [PMID: 34295089 DOI: 10.1007/s13193-021-01329-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Although the relative survival has improved in recent years still patients who present with metastatic disease have a less than 30% 5-year survival. Historically, removal of the primary breast tumor has been offered to these patients only for palliation. However, there have been recent reports that removal of the primary tumor may improve survival. These are mostly retrospective studies limited by selection bias. Prospective and randomized trials have not shown a clear survival advantage. Although the definitive role of removal of the primary tumor in metastatic breast cancer is not settled, it is critical to understand the complexities of this debate in order to make further gains in breast cancer survivorship.
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Affiliation(s)
- Gaurav Patel
- Department Of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine lines, Mumbai, 400020 India
| | - Bojja V Kishore Reddy
- Department Of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine lines, Mumbai, 400020 India
| | - Prakash Patil
- Department Of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine lines, Mumbai, 400020 India
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Yamaguchi K, Matsunuma R, Hayami R, Tsuneizumi M. Large Breast Tumor Ulceration and Quality of Life in an 80-Year-Old Woman. Case Rep Oncol 2021; 14:580-584. [PMID: 33976637 PMCID: PMC8077448 DOI: 10.1159/000514980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
Advanced breast cancer with skin ulceration, bleeding, and odor is associated with impaired quality of life (QoL). In patients with metastatic breast cancer, treatment aims to relieve symptoms, improve QoL, and slow the progression of cancer. Occasionally, it is extremely difficult to alleviate symptoms and improve QoL in patients with breast cancer and skin ulceration, especially elderly patients. Since patient age, patient preferences, and the expected survival benefit from treatment are factors that influence the selection of therapy, physicians should provide an optimal treatment for patients with metastatic disease depending on the situation. In this study, we report the case of an elderly patient with metastatic breast cancer who had substantial skin ulceration. In this patient, multidisciplinary treatment including chemotherapy, radiotherapy, and surgery resulted in significantly improved QoL.
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Affiliation(s)
- Kei Yamaguchi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryoichi Matsunuma
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryosuke Hayami
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
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35
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Locoregional Therapy for the Primary Tumour in Women with a De Novo Diagnosis of Metastatic Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Zhang J, Luo S, Qiu Z, Lin Y, Song C. Impact of Postoperative Radiotherapy on Survival of Patients With de novo Stage IV Breast Cancer: A Population-Based Study From the SEER Database. Front Oncol 2021; 11:625628. [PMID: 33816261 PMCID: PMC8012805 DOI: 10.3389/fonc.2021.625628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: In our study, we aimed to evaluate the role of postoperative radiotherapy for patents with de novo stage IV breast cancer. Patients and Methods: Patients diagnosed with stage IV breast cancer from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Those patients who received both chemotherapy and surgery and lived longer than 6 months were divided into radiotherapy and non-radiotherapy groups. Kaplan-Meier analysis and multivariate Cox proportional hazards models were used to estimate the survival outcomes before and after being 1:1 propensity score matched (PSM). Subgroup analyses stratified by age, subtype, status of distant metastasis, and surgery type were also performed. Results: Among 1,935 patients, 52% (1006) underwent radiotherapy while the non-radiotherapy group contained 48% (929). After PSM, a total of 1,520 patients in two groups of 760 patients were enrolled in this analysis. Kaplan-Meier and the multivariate survival analysis demonstrated that the radiotherapy group presented with a better prognosis compared to the non-radiotherapy group (after PSM, BCSS: Hazard Ratio, 0.697; 95% confidence interval, 0.59-0.823; P < 0.001; OS: Hazard Ratio, 0.707; 95% confidence interval, 0.601-0.831; P < 0.001). Further subgroup analyses showed the Luminal subtype (HR+/HER2-), triple-negative breast cancer (TNBC), and bone-only metastasis patients presented with the most promising survival in the radiotherapy group. Conclusions: Postoperative radiotherapy is associated with a significant survival advantages in BCSS and OS. It can be an optimal supplementary treatment for stage IV patients after surgery, especially for Luminal subtype, TNBC, and patients with a low metastatic burden.
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Affiliation(s)
- Jie Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Breast Surgery Institute, Fujian Medical University, Fuzhou, China
| | - Shiping Luo
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhaozhen Qiu
- Department of General Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chuangui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Breast Surgery Institute, Fujian Medical University, Fuzhou, China
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37
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Jackson BE, Greenup RA, Strassle PD, Deal AM, Baggett CD, Lund JL, Reeder-Hayes KE. Understanding and identifying immortal-time bias in surgical health services research: An example using surgical resection of stage IV breast cancer. Surg Oncol 2021; 37:101539. [PMID: 33706057 DOI: 10.1016/j.suronc.2021.101539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Surgical health services researchers are increasingly utilizing observational data to assess associations between treatments and outcomes, especially since some procedures are unable to be evaluated through randomized controlled trials. However, the results of many of these studies may be affected by the presence of immortal-time bias, which exists when treatment does not occur on Day 0 of the study. This bias can result in researchers overestimating a treatment benefit, or even observe a treatment benefit when none exists. In this paper, we describe what immortal-time bias is, the challenges it presents, and how to recognize and address it using the real-world example of surgical resection of the primary tumor for stage IV breast cancer throughout. In our example, we guide researchers and illustrate how the early studies, which did not account for immortal-time bias, suggested a protective benefit of surgery, and how these results were supplanted by more recent studies through identifying and addressing immortal-time bias in their design and analyses.
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Affiliation(s)
- Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA.
| | - Rachel A Greenup
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, USA
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, USA
| | - Katie E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
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38
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Huang Z, Zhou X, Tong Y, Zhu L, Zhao R, Huang X. Surgery for primary tumor benefits survival for breast cancer patients with bone metastases: a large cohort retrospective study. BMC Cancer 2021; 21:222. [PMID: 33663462 PMCID: PMC7934519 DOI: 10.1186/s12885-021-07964-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The role of surgery for the primary tumor in breast cancer patients with bone metastases (BM) remains unclear. The purpose of this study was to determine the impact of surgery for the primary tumor in breast cancer patients with BM and to develop prognostic nomograms to predict the overall survival (OS) of breast cancer patients with BM. METHODS A total of 3956 breast cancer patients with BM from the Surveillance, Epidemiology, and End Results database between 2010 and 2016 were included. Propensity score matching (PSM) was used to eliminate the bias between the surgery and non-surgery groups. The Kaplan-Meier analysis and the log-rank test were performed to compare the OS between two groups. Cox proportional risk regression models were used to identify independent prognostic factors. Two nomograms were constructed for predicting the OS of patients in the surgery and non-surgery groups, respectively. In addition, calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the performance of nomograms. RESULT The survival analysis showed that the surgery of the primary tumor significantly improved the OS for breast cancer patients with BM. Based on independent prognostic factors, separate nomograms were constructed for the surgery and non-surgery groups. The calibration and ROC curves of these nomograms indicated that both two models have high predictive accuracy, with the area under the curve values ≥0.700 on both the training and validation cohorts. Moreover, DCA showed that nomograms have strong clinical utility. Based on the results of the X-tile analysis, all patients were classified in the low-risk-of-death subgroup had a better prognosis. CONCLUSION The surgery of the primary tumor may provide survival benefits for breast cancer patients with BM. Furthermore, these prognostic nomograms we constructed may be used as a tool to accurately assess the long-term prognosis of patients and help clinicians to develop individualized treatment strategies.
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Affiliation(s)
- Zhangheng Huang
- Department of Clinical Medicine, Hangzhou Medical College, 481 Binwen Road, Hangzhou, Zhejiang Province China
- Chengde Medical University, Chengde, Hebei Province China
| | - Xin Zhou
- Chengde Medical University, Chengde, Hebei Province China
| | - Yuexin Tong
- Chengde Medical University, Chengde, Hebei Province China
| | - Lujian Zhu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province China
| | - Ruhan Zhao
- Chengde Medical University, Chengde, Hebei Province China
| | - Xiaohui Huang
- Department of Clinical Medicine, Hangzhou Medical College, 481 Binwen Road, Hangzhou, Zhejiang Province China
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39
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Hou N, Yi J, Wang Z, Yang L, Wu Y, Huang M, Hou G, Ling R. Development and validation of a risk stratification nomogram for predicting prognosis in bone metastatic breast cancer: A population-based study. Medicine (Baltimore) 2021; 100:e24751. [PMID: 33578627 PMCID: PMC10545337 DOI: 10.1097/md.0000000000024751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Bone metastasis seriously affects the survival of breast cancer. Therefore, the study aimed to explore the independent prognostic factors in bone metastatic breast cancer (BMBC) and to construct a prognostic nomogram that can accurately predict the survival of BMBC and strictly divide the patients into different risk stratification.Four thousand three hundred seventy six patients with BMBC from the surveillance, epidemiology, and end results database in 2010 to 2015 were collected and randomly divided into training and validation cohort. Multivariate Cox regression identified the independent prognostic factors of BMBC. A nomogram for predicting cancer-specific survival (CSS) in BMBC was created using R software. The predictive performance of the nomogram was evaluated by plotting receiver operating characteristic (ROC) curves and calibration curves.Marital status, race, age, T stage, tumor grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, brain metastasis, liver metastasis, lung metastasis, chemotherapy, and breast surgery were identified as independent prognostic factors for CSS of BMBC. The area under the ROC curve at 1-, 3-, and 5-year of the nomogram were 0.775, 0.756, and 0.717 in the internal validation and 0.785, 0.737, and 0.735 in the external validation, respectively. Calibration curves further confirmed the unbiased prediction of the model. Kaplan-Meier analysis verified the excellent risk stratification of our model.The first prognostic nomogram for BMBC constructed in our study can accurately predict the survival of BMBC, which may provide a practical tool to help clinicians evaluate prognosis and stratify the prognostic risk for BMBC, thereby determining which patients should be given intensive treatment and optimizing individual treatment strategies for BMBC.
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Affiliation(s)
- Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery
| | - Jun Yi
- Department of Thyroid, Breast and Vascular Surgery
| | - Zhe Wang
- Department of Thyroid, Breast and Vascular Surgery
| | - Lu Yang
- Department of Thyroid, Breast and Vascular Surgery
| | - Ying Wu
- Department of Thyroid, Breast and Vascular Surgery
| | | | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, PR China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery
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Somsekhar SP, Geeta K, Jain R, Nayyer R, Halder S, Malik VK, Parikh P, Aggarwal S, Koul R. Practical consensus recommendations regarding role of mastectomy in metastatic breast cancer. South Asian J Cancer 2020; 7:79-82. [PMID: 29721468 PMCID: PMC5909300 DOI: 10.4103/sajc.sajc_106_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Whether to recommend mastectomy in metastatic disease or not has been a matter of debate. Is local therapy, such as mastectomy, of any benefit in advanced breast cancer is the main question. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S P Somsekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
| | - K Geeta
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | - R Jain
- Department of Surgical Oncology, Action Cancer Hospital, New Delhi, India
| | - R Nayyer
- Department of Surgical Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - S Halder
- Department of Radiation Oncology, BLK Super Specialty Hospital, New Delhi, India
| | - V K Malik
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - R Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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41
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Liu C, Wang W, Shan Z, Zhang H, Yan Q. Dexmedetomidine as an adjuvant for patients undergoing breast cancer surgery: A meta-analysis. Medicine (Baltimore) 2020; 99:e23667. [PMID: 33327355 PMCID: PMC7738154 DOI: 10.1097/md.0000000000023667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis. METHODS Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software. RESULTS Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = -0.65) and morphine (total: SMD = -2.23; patient-controlled analgesia: SMD = -1.45) as well as intraoperative requirement for fentanyl (SMD = -1.60), and lower the pain score at 1 (SMD = -0.30), 2 (SMD = -1.45), 4 (SMD = -2.36), 6 (SMD = -0.63), 8 (SMD = -2.47), 12 (SMD = -0.81), 24 (SMD = -1.78), 36 (SMD = -0.92), and 48 (SMD = -0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05). CONCLUSION DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.
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Affiliation(s)
- Changjun Liu
- Operating Room, Yidu Central Hospital of Weifang
| | - Wei Wang
- Operating Room, Yidu Central Hospital of Weifang
| | | | - Huapeng Zhang
- Department of Anesthesiology, Yidu Central Hospital of Weifang
| | - Qiang Yan
- Intensive Care Unit, Weifang People's Hospital, Weifang, Shandong, China
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Jin S, Wei J, Wang J, Wang B, Wu J, Gan H, Dai B, Qin X, Lin G, Wei Y, Yang C, Shen Y, Zhu Y, Zhu Y, Ye D. Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study. Front Oncol 2020; 10:527952. [PMID: 33364186 PMCID: PMC7753115 DOI: 10.3389/fonc.2020.527952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 10/27/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Our study aims to examine the impact of definitive local therapy in prostate cancer patients with different metastatic sites. METHODS Totally, 5,849 patients diagnosed with metastatic prostate carcinoma from 2010 to 2014 were selected from Surveillance, Epidemiology, and End Results (SEER). Log-rank analyses, multivariable regression analysis, and Kaplan-Meier methods were used to assess prognostic impact of local treatment in patients with different metastatic sites. Survival curves and forest plots were also plotted to describe the prognostic value of definitive local therapy. RESULTS In our study, 159 patients received radical prostatectomy, and 62 received brachytherapy, while 5,628 did not receive local definitive local therapy. Survival analysis revealed that patients who received definitive local therapy had a better 5-year overall survival (OS) (P = 0.011) and cancer-specific survival (CSS) (P = 0.012). Multivariate regression analyses demonstrated that type of treatment was an independent prognostic indicator for OS (P = 0.011) and CSS (P = 0.012), along with age at diagnosis, chemotherapy, PSA level, and Gleason score. According to subgroup analysis, patients with bone metastasis or distant lymph node (LN) metastasis were significantly more likely to benefit from definitive local therapy. In addition, forest plots demonstrated that RP group had significant favorable OS and CSS in subgroups of younger age at diagnosis, T2-3 stage, N0-1 stage, Gleason score =7 or ≥8, bone metastasis, and distant LN metastasis. CONCLUSIONS Our study suggested that local therapy improved survival in prostate cancer patients with bone or distant LN metastasis. Furthermore, patients who were at T2-3 stage or Gleason score ≥7 also significantly benefit from definitive local therapy.
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Affiliation(s)
- Shengming Jin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaming Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junjie Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Beihe Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junlong Wu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hualei Gan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guowen Lin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lian CL, Guo LY, Zhang L, Wang J, Lei J, Hua L, He ZY, Wu SG. Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis. Front Oncol 2020; 10:522580. [PMID: 33282721 PMCID: PMC7706410 DOI: 10.3389/fonc.2020.522580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction To investigate the effect of local treatment strategy on survival outcome in de novo stage IV breast cancer patients who received chemotherapy. Methods We identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan–Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses. Results We identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM. Conclusions Compared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with de novo stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.
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Affiliation(s)
- Chen-Lu Lian
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li-Yi Guo
- The Sixth People's Hospital of Huizhou, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Lei Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Pons-Tostivint E, Alouani E, Kirova Y, Dalenc F, Vaysse C. Is there a role for locoregional treatment of the primary tumor in de novo metastatic breast cancer in the era of tailored therapies?: Evidences, unresolved questions and a practical algorithm. Crit Rev Oncol Hematol 2020; 157:103146. [PMID: 33227574 DOI: 10.1016/j.critrevonc.2020.103146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Improvements in systemic therapies have changed the face of de novo metastatic breast cancer (dnMBC), with a 5-year survival rate exceeding 25 %. Increasing evidence suggests that a subset of patients could benefit from a locoregional treatment (LRT) with prolonged survival, although the diversity of publications on the subject make it difficult to draw any conclusions. In this review, we summarize the available data on retrospective, prospective and current ongoing clinical trials. Since factors such as tumor biology, pattern of metastatic dissemination and the timing of the treatment are closely linked to the therapeutic strategy, we focus on papers which include these aspects. We discuss recent studies indicating that exclusive radiotherapy provides results comparable with those obtained by surgery. We will then discuss the biological rationale for LRT. Finally, we propose a decision-tree to select the optimal candidates for LRT in dnMBC patients.
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Affiliation(s)
- E Pons-Tostivint
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.
| | - E Alouani
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - Y Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - F Dalenc
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - C Vaysse
- Surgical Department, Toulouse University Hospital Center (CHU Toulouse), IUCT-Oncopole, 31000, Toulouse, France
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Zhao W, Wu L, Zhao A, Zhang M, Tian Q, Shen Y, Wang F, Wang B, Wang L, Chen L, Zhao X, Dong D, Zhang L, Yang J. A nomogram for predicting survival in patients with de novo metastatic breast cancer: a population-based study. BMC Cancer 2020; 20:982. [PMID: 33046035 PMCID: PMC7549197 DOI: 10.1186/s12885-020-07449-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND 5-10% of patients are diagnosed with metastatic breast cancer (MBC) at the initial diagnosis. This study aimed to develop a nomogram to predict the overall survival (OS) of these patients. METHODS de novo MBC patients diagnosed in 2010-2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. They were randomly divided into a training and a validation cohort with a ratio of 2:1. The best subsets of covariates were identified to develop a nomogram predicting OS based on the smallest Akaike Information Criterion (AIC) value in the multivariate Cox models. The discrimination and calibration of the nomogram were evaluated using the Concordance index, the area under the time-dependent receiver operating characteristic curve (AUC) and calibration curves. RESULTS In this study, we included 7986 patients with de novo MBC. The median follow-up time was 36 months (range: 0-83 months). Five thousand three-hundred twenty four patients were allocated into the training cohort while 2662 were allocated into the validation cohort. In the training cohort, age at diagnosis, race, marital status, differentiation grade, subtype, T stage, bone metastasis, brain metastasis, liver metastasis, lung metastasis, surgery and chemotherapy were selected to create the nomogram estimating the 1-, 3- and 5- year OS based on the smallest AIC value in the multivariate Cox models. The nomogram achieved a Concordance index of 0.723 (95% CI, 0.713-0.733) in the training cohort and 0.719 (95% CI, 0.705-0.734) in the validation cohort. AUC values of the nomogram indicated good specificity and sensitivity in the training and validation cohort. Calibration curves showed a favorable consistency between the predicted and actual survival probabilities. CONCLUSION The developed nomogram reliably predicted OS in patients with de novo MBC and presented a favorable discrimination ability. While further validation is needed, this may be a useful tool in clinical practice.
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Affiliation(s)
- Wen Zhao
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Lei Wu
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Andi Zhao
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Mi Zhang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Qi Tian
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yanwei Shen
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Fan Wang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Biyuan Wang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Le Wang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Ling Chen
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiaoai Zhao
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Danfeng Dong
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Lingxiao Zhang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Jin Yang
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, No 277 Yenta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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Primary tumor removal improves the prognosis in patients with stage IV breast cancer: A population-based study (cohort study). Int J Surg 2020; 83:109-114. [PMID: 32931976 DOI: 10.1016/j.ijsu.2020.08.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023]
Abstract
Adjuvant therapy including chemotherapy, hormonal therapy, and radiotherapy were often used as a common stereotypy for female stage IV breast cancer rather than surgery. This study aimed to define the role of local surgery in metastatic breast cancer. Female metastatic breast cancer patients were identified in the Surveillance, Epidemiology, and End Results (SEER) program data (2010-2013). We compared survival time between patients who received primary tumor removal (PTR) versus those who did not. Multivariate Cox regression models and competitive risk models were built to adjust potential confounders. Of 7669 female stage IV breast cancer patients, 2704 (35.3%) had surgery on their breast tumor and 4965 (64.7%) did not. In the entire cohort, women who underwent PTR had a 45% reduced risk of breast cancer-related death (multi-adjusted hazard ratio [HR], 0.55; 95% CI, 0.50 to 0.60) compared with women who did not undergo PTR (P < 0.001). In a cause-specific hazard model (CS model), the multivariable HRs (95% CI) for the association of PTR with breast cancer related-death were 0.54 (0.50-0.60) in the multivariate-adjusted analysis. Similar results were also observed in the sub-distribution hazard function model (SD model) with corresponding multivariate HRs (95%CI) of 0.57 (0.52-0.63). Our study suggested that PTR was associated with improved survival in female stage IV breast cancer patients. The role of PTR in these patients needs to be re-evaluated.
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He ZY, Lian CL, Wang J, Lei J, Hua L, Zhou J, Wu SG. Incorporation of biologic factors for the staging of de novo stage IV breast cancer. NPJ Breast Cancer 2020; 6:43. [PMID: 32964117 PMCID: PMC7477201 DOI: 10.1038/s41523-020-00186-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/06/2020] [Indexed: 01/12/2023] Open
Abstract
This study aimed to investigate the prognostic value of biological factors, including histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status in de novo stage IV breast cancer. Based on eligibility, patient data deposited between 2010 and 2014 were collected from the surveillance, epidemiology, and end results database. The receiver operating characteristics curve, Kaplan-Meier analysis, and Cox proportional hazard analysis were used for analysis. We included 8725 patients with a median 3-year breast cancer-specific survival (BCSS) of 52.6%. Higher histologic grade, HER2-negative, ER-negative, and PR-negative disease were significantly associated with lower BCSS in the multivariate prognostic analysis. A risk score staging system separated patients into four risk groups. The risk score was assigned according to a point system: 1 point for grade 3, 1 point if hormone receptor-negative, and 1 point if HER2-negative. The 3-year BCSS was 76.3%, 64.5%, 48.5%, and 23.7% in patients with 0, 1, 2, and 3 points, respectively, with a median BCSS of 72, 52, 35, and 16 months, respectively (P < 0.001). The multivariate prognostic analysis showed that the risk score staging system was an independent prognostic factor associated with BCSS. Patients with a higher risk score had a lower BCSS. Sensitivity analyses replicated similar findings after stratification according to tumor stage, nodal stage, the sites of distant metastasis, and the number of distant metastasis. In conclusion, our risk score staging system shows promise for the prognostic stratification of de novo stage IV breast cancer.
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Grants
- This work was partly supported by the National Natural Science Foundation of China (No. 81802600, 81872459), the Commission Young and Middle-aged Talents Training Project of Fujian Health Commission (No. 2019-ZQNB-25), the Science and Technology Planning Projects of Xiamen Science & Technology Bureau (No. 3502Z20174070), and the Natural Science Foundation of Guangdong Province (No. 2018A030313666, 2017A030310422).
- This work was partly supported by the National Natural Science Foundation of China (No. 81802600, 81872459), the Commission Young and Middle-aged Talents Training Project of Fujian Health Commission (No. 2019-ZQNB-25), and the Natural Science Foundation of Guangdong Province (No. 2018A030313666, 2017A030310422).
- This work was partly supported by the National Natural Science Foundation of China (No. 81802600, 81872459), the Commission Young and Middle-aged Talents Training Project of Fujian Health Commission (No. 2019-ZQNB-25), the Science and Technology Planning Projects of Xiamen Science & Technology Bureau (No. 3502Z20174070), and the Natural Science Foundation of Guangdong Province (No. 2018A030313666, 2017A030310422)..
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Affiliation(s)
- Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, 510060 Guangzhou, People’s Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People’s Republic of China
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Lin C, Wu J, Ding S, Goh C, Andriani L, Lu S, Shen K, Zhu L. Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery. J Natl Compr Canc Netw 2020; 17:1521-1528. [PMID: 31805535 DOI: 10.6004/jnccn.2019.7332] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with de novo metastatic breast cancer (MBC) constitute a heterogeneous group with different clinicopathologic characteristics and survival outcomes. Despite controversy regarding its prognostic value, primary tumor surgery may improve survival for selected patients. PATIENTS AND METHODS Patients with de novo MBC were identified using the SEER database and were then divided randomly into training and validation sets. A Fine-Gray competing risks model was developed to identify the variables associated with increased cancer-specific mortality in the training set. The M1 subdivision system was established based on the independent prognostic factors. Cumulative incidence curves were estimated and compared using Gray's test. RESULTS Involvement of brain or liver and number of metastatic sites were identified as independent prognostic factors in multivariate analysis. The M1 category was subdivided into 3 subcategories: M1a, single site involvement except brain and liver; M1b, liver involvement only, or multiple site involvement except brain and liver; and M1c, brain involvement regardless of number of metastatic sites, or liver and other sites involvement except brain (M1b vs M1a: subdistribution hazard ratio [SHR], 1.48; 95% CI, 1.29-1.68; M1c vs M1a: SHR, 2.45; 95% CI, 2.18-2.75). Patients with the M1a subtype benefited most from primary tumor surgery in the adjusted competing risks model (M1a: SHR, 0.57; 95% CI, 0.48-0.67, M1b: SHR, 0.62; 95% CI, 0.47-0.83, and M1c: SHR, 0.59; 95% CI, 0.44-0.80), whereas benefits conferred by treatment with chemotherapy alone increased with the upstaging of metastatic disease (M1a: SHR, 0.72; 95% CI, 0.62-0.83, M1b: SHR, 0.54; 95% CI, 0.44-0.68, and M1c: SHR, 0.53; 95% CI, 0.45-0.61). CONCLUSIONS Subdivision of M1 stage facilitates prognosis prediction and treatment planning for patients with de novo MBC. Treatment offered should be decided in a coordinated multidisciplinary setting. Primary tumor surgery may play an important role in the management of selected patients.
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Affiliation(s)
- Caijin Lin
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shuning Ding
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Chihwan Goh
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Lisa Andriani
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shuangshuang Lu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Ghannam Y, Bourgier C, Legouté F, Gonzalez-Moya A, Lizée T, Trémolières P, Hennequin C. [Treatment of primary disease with irradiation in case of de novo metastatic breast cancer]. Cancer Radiother 2020; 24:567-575. [PMID: 32814669 DOI: 10.1016/j.canrad.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022]
Abstract
Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France.
| | - C Bourgier
- Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier IRCM, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Inserm, U1194, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - F Legouté
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - A Gonzalez-Moya
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - P Trémolières
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris, France
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Zhao YY, Sun HF, Yang XL, Zhao Y, Chen MT, Jin W. Local Surgery Improves Survival in Patients with Primary Metastatic Breast Cancer: A Population-Based Study. Breast Care (Basel) 2020; 15:392-399. [PMID: 32982650 PMCID: PMC7490663 DOI: 10.1159/000503336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/12/2019] [Indexed: 11/19/2022] Open
Abstract
The clinical value of local surgery in the breast cancer patients with distant metastasis is still unclear. A total of 8,922 primary metastatic breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed in the current study. Primary outcome variables included breast cancer-specific survival (BCSS) and overall survival (OS). Among the patients, 1,724 (19.3%) who underwent surgical treatment (ST) of primary breast tumor had increased OS (p < 0.001) and BCSS (p < 0.001) compared with those in the nonsurgical treatment (NST) group. Multivariate analysis revealed that surgery improved survival and was an independent prognostic factor for OS (hazard ratio [HR] = 0.617; 95% confidence interval [CI], 0.562-0.676, p < 0.001) and BCSS (HR = 0.623; 95% CI, 0.565-0.686, p < 0.001). Further result showed that ST tended to prolong the survival of patients with 1 or 2 distant metastatic sites (p < 0.05 for OS, p < 0.05 for BCSS). However, no differences were found in prognostic outcomes between different surgical procedure groups (p = 0.886 for OS, p = 0.943 for BCSS). In conclusion, our study suggested that local surgery appeared to confer a survival benefit, which may provide new understanding of treatment for these patients.
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Affiliation(s)
- Yuan-Yuan Zhao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - He-Fen Sun
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xue-Li Yang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Meng-Ting Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Jin
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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