Prognostic factors for recurrent breast cancer patients with an isolated, limited number of lung metastases and implications for pulmonary metastasectomy

Abstract

BACKGROUND:The aim of this study was to evaluate the clinical treatment outcomes of recurrent breast cancer with a limited number of isolated lung metastases, and to evaluate the role of pulmonary metastasectomy. METH-ODS: The authors consecutively enrolled 140 recurrent breast cancer patients with isolated lung metastasis from 1997 to 2007 in Seoul National University Hospital and retrospectively analyzed 45 patients who had <4 metastatic lesions. RESULTS: Fifteen patients had pulmonary metastasectomy followed by systemic treatment (pulmonary metastasectomy group), and 30 received systemic treatment alone (nonpulmonary metastasectomy group). The 3-year progression-free survival (PFS) and 4-year overall survival (OS) was significantly longer in the pulmonary metastasectomy group than in the nonpulmonary metastasectomy group (3-year PFS, 55.0% vs 4.5%, P < .001; 4-year OS, 82.1% vs 31.6%, P ¼ .001). In multivariate analysis, a disease-free interval (DFI) of <24 months (hazard ratio [HR], 4.53; 95% CI, 1.72-11.90), no pulmonary metastasectomy (HR, 9.52; 95% CI, 3.34-27.18) and biologic subtypes such as human epithelial growth factor receptor-2 positive (HR, 3.00; 95% CI, 1.04-8.64) and triple negative (HR, 3.92; 95% CI, 1.32-11.59) were independent prognostic factors for shorter PFS. CONCLUSIONS: The authors' results demonstrated that DFI and biologic subtypes of tumor are firm, independent, prognostic factors for survival, and pulmonary metastasectomy can be a reasonable treatment option in this population. Further prospective studies are warranted to evaluate the role of pulmonary metastasectomy. Cancer 2010;116:2890-901.

Diagnosis and surgical resection of solitary pulmonary nodules in patients with breast cancer

“…The median survival period of pulmonary metastasis patients subsequent to systemic treatment remains approximately 24 months (19,20). Several studies have suggested that surgical treatment for operable lung metastases from breast cancer followed by systemic treatment prolongs survival to a greater extent compared to standard systemic treatment alone, in patients with <4 pulmonary metastases or with a DFI >3 years (21)(22)(23). The present study also suggests that pulmonary resection for solitary lung metastasis from breast cancer is likely to contribute to the improvement of prognosis, although a combined systemic therapy might be required.…”

“…Lung resection is a controversial treatment for pulmonary metastasis from breast cancer (5,(19)(20)(21)(22)(23). In this study, the five-year survival period for solitary lung metastasis from breast cancer patients was 100% after pulmonary resection.…”

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

“…(21,22) evolution of patients with isolated pulmonary metastatic disease remains a concern. (12) Expression of Ki-67, a tumor marker closely related to the process of cell proliferation, might represent a negative prognostic factor. (24,25) The breast cancer subtypes in which there is high Ki-67 expression have been shown to respond better to the initial chemotherapy but have also been associated with a poor long-term prognosis.…”

“…(8,9) Such pulmonary metastases have been associated with a poor prognosis. (10,11) Because the lungs are common sites of metastatic disease, (12) the identification of malignant cells in the pleural fluid, together with the results of a biopsy of the parietal pleura, can provide evidence that the primary disease has spread or progressed, and such progression has been associated with decreased life expectancy. (13) Therefore, we stress the importance of identifying organ-specific characteristics of metastatic breast cancer, because such data can further the understanding of the natural history of the disease.…”

Long-term outcomes and prognostic factors of pulmonary metastasectomy in breast cancer patients: a systematic review

“…[17,18] Pulmonary metastasectomy for metastatic breast cancer was begun more than two decades ago and, since then, few studies were performed which reported significant effects of metastasectomy in improving overall and long-term survival. [16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In a recent metaanalysis, the pooled overall five-year survival rate following pulmonary metastasectomy was found to be 46% in patients with breast cancer, while it was 22.5% following systemic treatment in patients with metastatic breast cancer. [34,35] In another study, Yhim et al [30] compared the results of pulmonary metastasectomy in 15 patients with metastatic breast cancer with 30 patients who received systemic treatment alone, and found significantly longer progression-free survival and overall survival in the metastasectomy group.…”