Incorporation of biologic factors for the staging of de novo stage IV breast cancer

Abstract

This study aimed to investigate the prognostic value of biological factors, including histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status in de novo stage IV breast cancer. Based on eligibility, patient data deposited between 2010 and 2014 were collected from the surveillance, epidemiology, and end results database. The receiver operating characteristics curve, Kaplan–Meier analysis, and Cox proportional hazard analysis were used for analysis. We included 8725 patients with a median 3-year breast cancer-specific survival (BCSS) of 52.6%. Higher histologic grade, HER2-negative, ER-negative, and PR-negative disease were significantly associated with lower BCSS in the multivariate prognostic analysis. A risk score staging system separated patients into four risk groups. The risk score was assigned according to a point system: 1 point for grade 3, 1 point if hormone receptor-negative, and 1 point if HER2-negative. The 3-year BCSS was 76.3%, 64.5%, 48.5%, and 23.7% in patients with 0, 1, 2, and 3 points, respectively, with a median BCSS of 72, 52, 35, and 16 months, respectively (P < 0.001). The multivariate prognostic analysis showed that the risk score staging system was an independent prognostic factor associated with BCSS. Patients with a higher risk score had a lower BCSS. Sensitivity analyses replicated similar findings after stratification according to tumor stage, nodal stage, the sites of distant metastasis, and the number of distant metastasis. In conclusion, our risk score staging system shows promise for the prognostic stratification of de novo stage IV breast cancer.

Prognostic Model for De Novo and Recurrent Metastatic Breast Cancer

“…32 More recent studies have proposed dividing the M1 stage in de novo MBC. [29][30][31] Our findings support modifying the current M1 stage 75,76 by classifying patients with de novo MBC into prognostic categories using a combination of clinical and tumor characteristics.…”

“…Given the heterogeneity of MBC outcomes, the results presented here could also support a novel substaging classification for patients with MBC. [29][30][31][32]…”

Factors Associated with Time to Progression and Overall Survival in Patients with De Novo Metastatic Breast Cancer: A Colombian Cohort

“…According to world literature, patients with HER2+ tumors have better outcomes in the metastatic setting than those with HER2-negative or triple-negative tumors. 12 , 21 , 27 , 29 However, in this study, although the highest mortality rate was observed in patients with triple-negative tumors, those with HER2+ BC had the highest progression rate. This is probably because Colombia’s health system structure promotes a differentiated and unequal health care for its citizens, based mainly on their financial capacity.…”

“…Neuman et al 26 noted that the status of hormone and HER2 receptors were the variables that best predicted survival in de novo MBC; but, unlike the present work, they observed that patients with HER2+ tumors had better survival, something they attributed to the availability of effective targeted therapy. He et al 27 also studied the value of some biological factors in de novo MBC, finding that patients with high-grade, HER2-negative, single hormone receptor-positive, or triple-negative tumors had lower BC-specific survival. These biomarkers showed a good prognostic performance so the authors consider it worthwhile to incorporate them into a new staging system for patients diagnosed in stage IV, as occurs in the 8th edition of the American Joint Committee on Cancer staging system for non-metastatic BC.…”

“… 2 , 3 In the same way, the median OS of patients in this study (2.4 years (95% CI: 2-4.3) or 28.8 months) is lower than the 39 to 48 months reported in recent publications. 20 , 27 This situation can be explained, on the one hand, by the high burden of disease at the time of diagnosis (90.8% had T4 tumors, 77.7% had N2/N3 tumors, and 83.4% had multiple metastatic sites), which indicates a low coverage of mammography screening, ranging between 32% and 50%, 48 and a late disease diagnosis, as a consequence of poor access to health services, either due to administrative barriers or the absence of specialized oncology services in a large part of the country. On the other hand, it can also be explained by a cancer treatment that is below the current standards, reflected in late start and lack of continuity in treatments, as well as in the absence of access to the newest available therapies.…”