Prognostic significance of the number of bone scan abnormalities at the time of initial bone metastatic recurrence in breast carcinoma

Abstract

BACKGROUND To gain insight into the factors that contribute to the more favorable prognosis associated with recurrence limited to bone in patients with breast carcinoma, the authors analyzed the number of sites of initial involvement identified on radionuclide bone scans in relation to long term outcome. METHODS Records of 641 patients with clinical Stage I–III breast carcinoma that originally was diagnosed in 1974–1985 were reviewed. During follow‐up, 295 patients (46%) experienced distant recurrence, including 116 with bone as the sole initial site of metastatic disease. Radionuclide bone scans identified the initial site(s) of recurrence in 113 of these latter 116 patients, and these studies were categorized by the number of skeletal lesions subsequently confirmed as metastases (1, 2, or ≥ 3). Survival from time of recurrence and time of original diagnosis was analyzed using Kaplan–Meier methods, and factors associated with recurrence and mortality were examined using logistic and Cox regression. RESULTS Median survival from time of recurrence was 35 months in the patients with bone‐only metastases, compared with 11–26 months for all other sites of visceral recurrence exclusive of bone. Number of positive lymph nodes and estrogen receptor status were the only predictive variables for recurrence. Median survival from time of recurrence and time of original diagnosis for the 3 bone scan categories was: 1 lesion (n = 47), 53 and 86 months; 2 lesions (n = 22), 38 and 68 months; and ≥ 3 lesions (n = 44), 22 and 58 months (P < 0.0001 and P < 0.005 for 1 and 2 lesions vs. ≥ 3). In the “bone‐only” group, the number of scan lesions was the strongest predictor of length of survival. CONCLUSIONS Patients with breast carcinoma who experience a recurrence in bone at only one or two sites initially have a survival advantage over those with more extensive (≥ 3 sites) skeletal metastases and those with metastatic disease involving other visceral organs. Cancer 2001;91:17–24. © 2001 American Cancer Society.

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

“…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.…”

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

“…Patients with a solitary hot spot on bone scan had significantly improved survival compared to patients with two or more hot spots. It has previously been reported that patients who have bone recurrence at initially only one or two sites on bone scan experience a survival advantage over those with more extensive skeletal metastases (Jacobson et al, 2001). Care needs to be taken when interpreting this finding, as a possible explanation for the apparent better outcome may be that a solitary hot spot on a bone scan has been incorrectly classified as malignant.…”

Importance of the development time of isolated bone metastasis in breast cancer

“…Innovation in adjuvant therapy results in improved survival over time. The number of metastatic sites and the type of metastatic tumor load also affect survival [3][4][5][6][7]. Prior reports have shown that patients with metastatic spread limited to the skeleton have a relatively prolonged survival [7][8][9][10].…”