Survival with metastatic breast cancer based on initial presentation, de novo versus relapsed

Brok, Wendie Den; Speers, Caroline; Gondara, Lovedeep; Baxter, Emily; Tyldesley, Scott; Lohrisch, Caroline A.

doi:10.1007/s10549-016-4080-9

Cited by 160 publications

(106 citation statements)

References 29 publications

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“…Considering the differences in traditional concepts among people in different regions, the Chinese are pursuing active and comprehensive treatment, while the Western population is pursuing a higher quality of life, which may have led to the above-mentioned differences in treatment. Prior reports state that the median survival time of patients with MBC was 2-3 years (7,9,(15)(16)(17)(18). Andre et al (7) reported that the median survival time of patients with DnMBC was 23 months in 1987-1993, compared with 29 months in 1994-2000, of which most patients had single metastasis especially bone metastasis, >80% had received chemotherapy and 51% had received local surgery or radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

De�novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Zhang

et al. 2020

Oncol Lett

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The purpose of the present study was to analyze the clinical and pathological characteristics, treatment, and prognosis of de novo metastatic breast cancer (DnMBC). Information regarding 1,890 patients treated for advanced breast cancer at the Tianjin Medical University Cancer Hospital between January 2008 to December 2017 was collected. Clinicopathological characteristics, treatments and outcomes of these patients were compared using the chi-square test, log-rank test, and Cox regression analysis. A total of 171 patients were diagnosed with DnMBC. The median age at diagnosis was 53 years (range, 23-77). The percentage of T4 staging was higher (37.4%), 69.6% of patients were estrogen receptor (ER) positive, 59.1% were progesterone receptor positive, 29.8% had positive human epidermal growth factor receptor 2 (HER2) status, 68.4% had Ki-67 ≥20%, 55% had oligometastasis at the initial diagnosis, ~87.7% were treated with chemotherapy initially and 24% received palliative surgery for the primary tumor. After a median follow-up time of 26 months, the median progression-free survival (PFS) and overall survival (OS) among patients with DnMBC were 11 (8.7-13.3) months and 34 (27.9-40.1) months, respectively. In the multivariable model, ER status and sites of first metastasis (oligometastasis or polymetastasis) were identified to be independent predictors of PFS (P<0.05); ER status, primary tumor stage, and surgical treatment of primary tumors were identified to be independent predictors of OS (P<0.05). In conclusion, the clinicopathological characteristics of DnMBC are greater invasiveness and a higher risk of progression. Palliative surgical treatment may improve the prognosis of HR+/HER2-patients with oligometastasis. Therefore, individualized treatment as required is particularly important.

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Section: Discussionmentioning

confidence: 99%

De�novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Zhang

et al. 2020

Oncol Lett

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“…When examining de novo Stage IV patients, the current survival is in the range of 27-29 months. 28,29 Survival is notably higher for hormone receptor positive disease (34 months) and HER2 positive disease (29 months) when compared with triple negative breast cancer (11 months). These results are in line with the findings of this study.…”

Section: Discussionmentioning

confidence: 99%

Surgery and survival in patients with stage IV breast cancer

et al. 2019

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Background Retrospective studies have shown some improvement in survival for patients receiving surgical management of the intact primary tumor in patients with presenting with Stage IV disease, while prospective studies have revealed mixed results. Methods An examination of the NCDB from 2004‐2013 was undertaken to examine factors related to the utilization of surgery and overall survival in patients with de novo Stage IV disease. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was implemented to balance patients' baseline characteristics. Results A total of 11 694 patients with Stage IV breast cancer at diagnosis met inclusion criteria. Surgical intervention occurred in 5202 patients (44.5%), with the use of surgery decreasing throughout the study period (53.6% surgery 2004‐2006; 31.8% surgery 2011‐2013). Selection for surgical intervention was associated with small tumors (T1) and a higher nodal burden (N2/3). Uninsured patients, those treated at academic centers, those treated in the Northeast, and those with hormone receptor positive tumors were less likely to undergo surgery. Surgery was independently associated with a better overall survival. Propensity score matching revealed a persistent survival advantage for surgical patients receiving surgery, regardless of the receipt of systemic therapy. Conclusions Surgery on the intact primary tumor for patients presenting with de novo Stage IV breast cancer is associated with improved overall survival. Surgical resection in patients with Stage IV breast cancer should be considered for well‐selected patients as a part of multimodality therapy.

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“…In the de novo cohort, 54 patients who underwent primary cancer surgery had significantly better progression-free survival (PFS) and overall survival (OS; hazard ratio [HR] = 0.44; 95% confidence interval [CI]: 0.26-0.72 and HR = 0.49; 95% CI: 0.26-0.93, respectively) than those who did not have surgery [11]. Several other studies that examined clinical features that are associated with long-term survival of HER2 positive MBC treated with HER2-targeted therapies identified hormone receptor positivity, oligometastatic disease, surgical resection of metastases and/or primary tumor, and no prior exposure to HER2-targeted therapies (in the adjuvant setting) as predictors of long-term survival [7][8][9][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…This has resulted in overall fewer HER2 positive MBC and in a relative increase in the proportion of de novo stage IV disease among patients with HER2 positive metastatic disease. Historically, de novo stage IV breast cancer accounted for 6%-20% of metastatic breast cancers across subtypes, but recent studies reported that over 50% of metastatic HER2 breast cancers today represent de novo stage IV disease [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival of De Novo Stage IV Human Epidermal Growth Receptor 2 (HER2) Positive Breast Cancers Treated with HER2-Targeted Therapy

et al. 2018

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In this retrospective review at two institutions, it was demonstrated that 13% of patients with de novo stage IV, human epidermal growth receptor 2 positive metastatic breast cancer achieved no evidence of disease (NED) status with trastuzumab-based therapy plus/minus local therapies, and these patients had a very high progression-free survival (100%) and overall survival (98%) at both the 5- and 10-year time points. Achieving NED status may be an important therapeutic goal. However, further randomized studies are required to fully understand the impact of systemic or locoregional therapy on achieving these excellent long-term outcomes.

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Survival with metastatic breast cancer based on initial presentation, de novo versus relapsed

Abstract: These data provide information that may guide discussions about prognosis between physicians and patients with MBC. In addition, it highlights the importance of stratifying for initial stage at diagnosis in future MBC therapeutic trials.

Cited by 160 publications

References 29 publications

De�novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

De�novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Surgery and survival in patients with stage IV breast cancer

Long-Term Survival of De Novo Stage IV Human Epidermal Growth Receptor 2 (HER2) Positive Breast Cancers Treated with HER2-Targeted Therapy

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