Metastatic breast cancer: clinical course, prognosis and therapy related to the first site of metastasis

Solomayer, Erich‐Franz; Diel, Ingo J.; Meyberg, G.; Gollan, Ch.; Bastert, G.

doi:10.1023/a:1006308619659

Cited by 324 publications

(222 citation statements)

References 25 publications

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“…A shorter metastasis-free interval also had a negative impact on survival in patients with bone metastases. This confirms previous work recognising the prognostic importance of the metastasis-free interval (Solomayer et al, 2000). A short metastasis-free interval also tends to suggest a more aggressive, rapidly growing tumour.…”

Section: Discussionsupporting

confidence: 89%

“…Low-grade and ER-positive tumours were more likely to be associated with the development of bone metastases. Others have also found similar relationships (Koenders et al, 1991;Coleman et al, 1998;Solomayer et al, 2000). The same factors were also found to influence survival in patients presenting with bone metastases.…”

Section: Discussionmentioning

confidence: 53%

“…Others have also confirmed the importance of site of initial metastases in determining prognosis (Blanco et al, 1990;Robertson et al, 1992;Coleman et al, 1998;Solomayer et al, 2000).…”

Section: Discussionmentioning

confidence: 86%

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Bone metastases from breast carcinoma: histopathological – radiological correlations and prognostic features

et al. 2003

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The aim of this study was to identify factors that may be associated with the development of bone metastases in patients with metastatic breast carcinoma and to see if any of these factors had a bearing on subsequent survival. In total, 492 patients presented to the Nottingham City Hospital with metastatic breast carcinoma between July 1997 and December 2001. Of these, 267 patients had bone metastases at presentation with metastatic disease, 91 patients in this group had bone as their only site of metastatic disease. Sites of first presentation of metastatic disease were prospectively recorded, as were histological features of the primary tumour (tumour type, histological grade, lymph node stage, tumour size and oestrogen receptor (ER) status). The radiological features of the bone metastases, the metastasis-free interval and serological tumour marker levels at presentation with metastases were all recorded. There was a significant association between the development of bone metastases and lower grade tumours (P ¼ 0.019), ER-positive tumours (Po0.0001) and the lymph node stage of the primary tumour (P ¼ 0.047). A multivariate analysis found that metastasis-free interval, additional sites of metastatic disease other than bone, ER status and serological tumour marker levels all independently contributed to survival from time of presentation with bone metastases. British Journal of Cancer (2003) The survival of patients with metastases is variable ranging from a matter of months to many years. The ability to predict prognosis and response to treatment has a considerable impact on patient management. It is well established that oestrogen receptor (ER) status and site of presentation of metastatic disease have the greatest impact on patient survival, with additional contributions made by patient age, disease-free interval and histological grade.Bone is the most common site of metastases in patients with breast carcinoma and so patients with bone metastases make up the largest single group of patients presenting with metastatic disease. It has previously been reported that 20% of patients with bone metastases survive for more than 5 years, which emphasises the wide variation in survival seen in this group of patients (Coleman et al, 1987). The aim of this study was to identify factors that may be associated with the development of bone metastases and to see if any of these factors had any bearing on subsequent survival.We have assessed traditional factors such as ER status, histological grade, lymph node stage and size of the primary tumour, patient age, metastasis-free interval and the presence of metastases at sites other than bone. We have examined the radiological appearance of the bone metastases and looked for associations with the histological features of the tumour and patient survival. In common with other centres, we increasingly use serological tumour markers in the diagnosis and monitoring of patients with metastatic breast carcinoma. The prognostic significance of elevated tumour markers at presentation ...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 53%

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Bone metastases from breast carcinoma: histopathological – radiological correlations and prognostic features

et al. 2003

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“…A recent study showed that compared with patients with visceral metastases with or without bone metastases, patients with bone‐only metastases at start of first‐line therapy had an improved median OS (54 months vs 28 months) 29. Other studies also found that the median survival of patients with bone‐only metastases was approximately twofold to threefold that of patients with additional visceral metastases 30, 41, 42, 43. The results of our cohort study reached the same conclusion that patients with metastases to the bone only had better survival than those with metastases to both the bone and extraosseous sites.…”

Section: Discussionmentioning

confidence: 99%

Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Gong

Zhang

et al. 2018

Cancer Medicine

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IntroductionPopulation‐based data on the incidence and prognosis of bone metastases at diagnosis of breast cancer are currently limited. Hence, we conducted this study to analyze the incidence proportions and prognostic factors of patients with breast cancer and bone metastases at the time of cancer diagnosis.Materials and methodsPatients with primary invasive breast cancer and bone metastases at initial diagnosis between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results (SEER) dataset and Fudan University Shanghai Cancer Center (FUSCC) cohort. Multivariable logistic regression was performed to identify predictors of the presence of bone metastases at diagnosis. Univariate and multivariate analyses were performed to determine the effects of each variable on survival.ResultsOf 229, 195 patients from SEER database included in the analysis, 8295 patients had bone metastases at initial diagnosis, reflecting 3.6% of the entire study population, and 65.1% of the subset with metastatic disease to any distant site. Patients with hormone receptor (HR)‐positive human epidermal growth factor receptor 2 (HER2)‐negative represented the highest incidence proportions among patients with metastatic disease (73.9%). Among entire cohort, multivariable logistic regression identified eight factors as predictors of the presence of bone metastases at diagnosis. Median OS for the patients with bone metastases in SEER and FUSCC cohorts was 30.0 and 68.2 months, respectively. Patients with HR‐positive HER2‐positive subtype had the longest median OS, and patients with triple‐negative subtype showed the shortest median OS. Multivariable Cox model in SEER cohort confirmed age, histology, grade, tumor subtype, extraosseous metastatic sites, history of primary surgery, insurance status, marital status, and income as independent prognostic factors for both OS and BCSS.ConclusionsThe findings of this study provide population‐based estimates of the incidence and prognosis for patients with bone metastases at initial diagnosis of breast cancer.

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“…Advanced breast cancer patients with visceral metastases (VM) are often regarded as having a worse prognosis and being less likely to respond to hormonal therapy than those with metastases in soft tissue and bone [1]. To date, cytotoxic therapies have provided the mainstay of treatment for patients with VM, with various mono-and polychemotherapy regimens proving efficacious in such patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

Activity of fulvestrant versus exemestane in advanced breast cancer patients with or without visceral metastases: data from the EFECT trial

Mauriac

Romieu²,

Bines

2008

Breast Cancer Res Treat

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Purpose Patients with visceral metastases (VM: lung and/or liver metastases) are generally regarded as being less responsive to hormonal therapy, and chemotherapy often becomes the default treatment. This paper reports a subgroup analysis from EFECT (The Evaluation of Faslodex versus Exemestane Clinical Trial) examining the efficacy of fulvestrant and exemestane in patients with or without VM. Methods EFECT is a randomised, doubleblind, multicentre, Phase III trial in postmenopausal women with advanced breast cancer progressing or recurring after prior non-steroidal aromatase inhibitor therapy. Results Overall, approximately 57% of patients in EFECT had visceral involvement. Fulvestrant and exemestane demonstrated clinical benefit in 29.1% and 27.2% of patients with VM, respectively. Median duration of response was 13.5 vs 10.8 months and median duration of clinical benefit was 9.9 vs 8.1 months, respectively. Conclusions These results encourage the use of endocrine agents such as fulvestrant in treating patients with advanced breast cancer and VM.

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Metastatic breast cancer: clinical course, prognosis and therapy related to the first site of metastasis

Cited by 324 publications

References 25 publications

Bone metastases from breast carcinoma: histopathological – radiological correlations and prognostic features

Bone metastases from breast carcinoma: histopathological – radiological correlations and prognostic features

Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis

Activity of fulvestrant versus exemestane in advanced breast cancer patients with or without visceral metastases: data from the EFECT trial

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