Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis

Leone, Bernardo Amadeo; Vallejo, Carlos; Romero, A; Machiavelli, M; Pérez, J. Eduardo; Leone, Julieta; Leone, José Pablo

doi:10.1007/s10549-016-4066-7

Cited by 86 publications

(102 citation statements)

References 24 publications

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“…We would like to make the following observations: First, our study found no significant differences in the distribution of laterality [1]. Based on this, we think that elaborating conclusions about the role of laterality in the development of metastatic disease should be avoided as it could be misleading.…”

Section: Dear Editormentioning

confidence: 61%

“…In the same, Altundag discusses the effect of laterality in our study and compares our results with a study evaluating the rates of metastases among patients with N3 disease. The author also describes the anatomical differences between the right and left lymphatic drainages and suggests a potential role in the development of distant metastases.We would like to make the following observations: First, our study found no significant differences in the distribution of laterality [1]. Based on this, we think that elaborating conclusions about the role of laterality in the development of metastatic disease should be avoided as it could be misleading.…”

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confidence: 61%

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Breast cancer is a systemic disease rather than an anatomical process

Leone¹,

Leone²,

Leone

2017

Breast Cancer Res Treat

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We read with great attention the letter from Altundag. In the same, Altundag discusses the effect of laterality in our study and compares our results with a study evaluating the rates of metastases among patients with N3 disease. The author also describes the anatomical differences between the right and left lymphatic drainages and suggests a potential role in the development of distant metastases.We would like to make the following observations: First, our study found no significant differences in the distribution of laterality [1]. Based on this, we think that elaborating conclusions about the role of laterality in the development of metastatic disease should be avoided as it could be misleading. Second, it has been known for several decades that breast cancer is a systemic disease and that the risk of distant metastases depends more on the tumor biology rather than the laterality, anatomical site, and its corresponding lymphatic drainage [2]. In fact, our study shows that tumor subtypes are clearly associated with specific sites of metastases, as shown by our adjusted logistic regression model [1]. Third, our results should not be interpreted in the way Altundag proposes, because our study analyzed patients who already had established metastases at initial diagnosis, rather than patients who would be at risk for such event.

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Section: Dear Editormentioning

confidence: 61%

mentioning

confidence: 61%

Breast cancer is a systemic disease rather than an anatomical process

Leone¹,

Leone²,

Leone

2017

Breast Cancer Res Treat

Self Cite

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“…There is growing evidence indicating that patterns of metastases vary between different hormone receptor (HR) and human epithelial growth factor receptor 2 (HER2) statuses of breast tumors 11, 12, 13, 14, 15, 16, 17, 18. Patients with HR‐positive breast cancer are at increased risk for the development of bone metastases, whereas bone metastases are less frequent in cases of triple‐negative tumors 15, 16, 17, 18, 19, 20, 21.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with HR‐positive breast cancer are at increased risk for the development of bone metastases, whereas bone metastases are less frequent in cases of triple‐negative tumors 15, 16, 17, 18, 19, 20, 21. Previous studies also indicated that tumor subtype is an important prognostic factor for the survival of patients with bone metastases, where worse survival was seen in patients with triple‐negative breast cancer 22, 23…”

Section: Introductionmentioning

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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“…They showed substantial differences in overall survival according to MP and found that tumor subtypes have a clear influence among other factors on specific sites of metastases [1]. Among the study variables, laterality was also analyzed.…”

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The effects of laterality in stage IV breast cancer patients at initial diagnosis; much work is needed!

Altundağ

2017

Breast Cancer Res Treat

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I want to congratulate Leone and colleagues for their article in which they analyzed prognostic impact of metastatic pattern (MP) in 9143 stage IV breast cancer patients at initial diagnosis. They showed substantial differences in overall survival according to MP and found that tumor subtypes have a clear influence among other factors on specific sites of metastases [1]. Among the study variables, laterality was also analyzed. Interestingly, left laterality was found to be more frequent than right laterality with trend toward significance (48.7 vs. 46.2% in all groups, 49.1 vs. 45.3% in bone only groups, p = 0.06) in IV breast cancer patients at initial diagnosis. Development of metastasis in patients with breast cancer (BC) is the most important negative prognostic factor, and this process mainly begins with lymphatic involvement. Therefore, axillary, subclavicular, internal mammary, or supraclavicular nodal involvement is a crucial step before metastasis. Anatomical differences between the right and left lymphatic drainages of the breasts may significantly affect the rate, site, and time to development of distant metastasis. We hypothesized that clinical variations related to laterality may be partly due to the following factors: different number of involved lymph nodes in each half of the body and/or different lymphatic flow between the right and left side. As previously stated, the left lymphatic duct, which takes the lymphatic flow of the left breast, takes also the lymphatic drainage of lower extremities, left abdomen, left hemithorax, left side of the head and neck, and the left arm, amounting to drainage of threefold greater area compared to that of the right lymphatic duct, whereas the right lymphatic duct, which drains the right breast, only receives the lymphatics of the organs above the level of umbilicus and right hemithorax, right side of the head and neck, and the right arm. In addition, the right lymphatic duct is much shorter and has a simpler structure compared to the left lymphatic duct [2]. We then explored if laterality is an independent prognostic factor for metastasis in N3 breast cancer patients. An interesting finding was that despite the higher T stage in the right breast cancer group, patients with left breast cancer developed a significantly higher rate of overall distant and axial bone metastases correlated well with current study findings and had shorter time to first metastasis, supporting our hypothesis of the negative effect of laterality [3]. In conclusion, the effects of laterality need to be explored throughly in stage IV breast cancer patients at initial diagnosis.Compliance with ethical standards

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Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis

Abstract: There were substantial differences in OS according to MP. Tumor subtypes have a clear influence among other factors on SSM. We identified several prognostic factors that could guide therapy selection in treatment naïve patients.

Cited by 86 publications

References 24 publications

Breast cancer is a systemic disease rather than an anatomical process

Breast cancer is a systemic disease rather than an anatomical process

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

The effects of laterality in stage IV breast cancer patients at initial diagnosis; much work is needed!

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