Prognostic factors effecting the survival in patients with initially metastatic breast cancer

Abstract

OBJECTIVES There have not been much data in literature related to the prognostic factors effecting survival in patients with initially metastatic breast cancer. METHODS To evaluate these factors, 44 patients with initially metastatic breast cancer who had adequate clinical and follow-up records were involved into this study. The biological characteristics of primary tumor were investigated by using immuno-histochemical methods. And also, the effects of histological and nuclear grade of the tumor, patients' age, visceral metastasis and performance status on survival were investigated. Median overall survival was 39 months (%95 confidential interval: 27.6-50.4). Lower performance status and presence of visceral metastasis were found to be the factors effecting the survival in univariate analysis (p≤0.05). CONCLUSION Lower performance status, hormone receptor negativity and presence of visceral metastasis were found to be as negative factors effecting overall survival in multivariate analysis (p≤0.05).

Keywords

• Breast Neoplasms,Carcinoma, Ductal, Breast,Neoplasm Metastasis,Prognosis,Time Factors,Survival Analysis

İlk tanıda metastatik meme kanseri ile başvuran hastaların sağkalımını etkileyen prognostik faktörler

Öz

AMAÇ İlk tanıda metastatik hastalık saptanan meme kanserli hastalarda sağkalımı etkileyen prognostik faktörler araştırıldı. GEREÇ VE YÖNTEM Bu çalışmaya ilk tanı anında metastaz saptanan, yeterli klinik ve izlem verisi bulunan meme kanserli toplam 44 hasta alındı. Primer tümörün biyolojik özellikleri immunohistokimyasal yöntemle değerlendirildi. Ayrıca histolojik ve nükleer derece, hasta yaşı, viseral metastaz durumu ve performans durumu gibi parametrelerin sağkalım üzerine etkisi araştırıldı. BULGULAR Medyan genel sağkalım süresi 39 ay (%95 güven aralığı: 27.6-50.4) bulundu. Tek değişkenli analizde genel sağkalımı olumsuz etkileyen faktörlerin düşük performans durumu ve viseral metastaz görülmesi olduğu saptandı (p < =0.05). SONUÇ Genel sağkalım için yapılan çok değişkenli analizde, genel sağkalımı olumsuz etkileyen en önemli faktörlerin düşük performans durumu, hormon reseptör negatifliği ve viseral metastaz varlığının olduğu gösterildi (p < = 0.05).

Anahtar Kelimeler

• Kanser, kanal, meme, meme neoplazi/mortalite/patoloji/terapi, neoplazi metastaz, prognoz, zaman faktörü, sağkalım analizi

Kaynakça

1. 1. Honig SF. Treatment of metastatic disease. In: Harris JR, Lippman ME, Morrow M, Hellman S, editors. Diseases of the breast. 1st ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 669-734.
2. 2. Honig SF. Hormonal therapy and chemotherapy. In: Harris JR, Morrow M, Lippman ME, Hellman S, editors. Diseases of the breast. 1st ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 669-734.
3. 3. Clark GM, Sledge GW Jr, Osborne CK, McGuire WL. Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol 1987;5(1):55-61.
4. 4. Howell A, Barnes DM, Harland RN, Redford J, Bramwell VH, Wilkinson MJ, et al. Steroid-hormone receptors and survival after first relapse in breast cancer. Lancet 1984;1(8377):588-91.
5. 5. Chang J, Clark GM, Allred DC, Mohsin S, Chamness G, Elledge RM. Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor. Cancer 2003;97(3):545-53.
6. 6. Insa A, Lluch A, Prosper F, Marugan I, MartinezAgullo A, Garcia-Conde J. Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat 1999;56(1):67-78.
7. 7. Parnes HL, Cirrincione C, Aisner J, Berry DA, Allen SL, Abrams J, et al. Phase III study of cyclophosphamide, doxorubicin, and fluorouracil (CAF) plus leucovorin versus CAF for metastatic breast cancer: Cancer and Leukemia Group B 9140. J Clin Oncol 2003;21(9):1819-24.
8. 8. Efficace F, Biganzoli L, Piccart M, Coens C, Van Steen K, Cufer T, et al. Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. Eur J Cancer 2004;40(7):1021-30.

9. 9. Williams MR, Todd JH, Nicholson RI, Elston CW, Blamey RW, Griffiths K. Survival patterns in hormone treated advanced breast cancer. Br J Surg 1986;73(9):752-5.
10. 10. Robertson JF, Dixon AR, Nicholson RI, Ellis IO, Elston CW, Blamey RW. Confirmation of a prognostic index for patients with metastatic breast cancer treated by endocrine therapy. Breast Cancer Res Treat 1992;22(3):221-7.
11. 11. Blanco G, Holli K, Heikkinen M, Kallioniemi OP, Taskinen P. Prognostic factors in recurrent breast cancer: relationships to site of recurrence, disease-free interval, female sex steroid receptors, ploidy and histological malignancy grading. Br J Can1990;62(1):142-6.
12. 12. Kramer JA, Curran D, Piccart M, de Haes JC, Bruning P, Klijn J, et al. Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 2000;36(12):1498-506.
13. 13. Paik S, Hazan R, Fisher ER, Sass RE, Fisher B, Redmond C, et al. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: prognostic significance of erbB-2 protein overexpression in primary breast cancer. J Clin Oncol 1990;8(1):103-12.
14. 14. Andrulis IL, Bull SB, Blackstein ME, Sutherland D, Mak C, Sidlofsky S, et al. neu/erbB-2 amplification identifies a poor-prognosis group of women with node-negative breast cancer. Toronto Breast Cancer Study Group. J Clin Oncol 1998;16(4):1340-9.
15. 15. Gusterson BA, Gelber RD, Goldhirsch A, Price KN, Save-Soderborgh J, Anbazhagan R, et al. Prognostic importance of c-erbB-2 expression in breast cancer. International (Ludwig) Breast Cancer Study Group. J Clin Oncol 1992;10(7):1049-56.
16. 16. Thor AD, Moore DH II, Edgerton SM, Kawasaki ES, Reihsaus E, Lynch HT, et al. Accumulation of p53 tumor suppressor gene protein: an independent marker of prognosis in breast cancers. J Natl Cancer Inst 1992;84(11):845-55.
17. 17. Allred DC, Clark GM, Elledge R, Fuqua SA, Brown RW, Chamness GC, et al. Association of p53 protein expression with tumor cell proliferation rate and clinical outcome in node-negative breast cancer. J Natl Cancer Inst 1993;85(3):200-6.
18. 18. Niskanen E, Blomqvist C, Franssila K, Hietanen P, Wasenius VM. Predictive value of c-erbB-2, p53, cathepsin-D and histology of the primary tumour in metastatic breast cancer. Br J Cancer 1997;76(7):917-