Abstract P2-14-10: Metastatic pattern discriminates survival benefit of primary surgery for de novo stage IV breast cancer patients: A longitudinal cohort study

598 Background: Limited data exists regarding optimal local therapy for patients who present with stage IV breast cancer with an intact primary tumor. Two retrospective series, from the National Cancer Data Base and the Geneva Cancer Registry, showed that surgery may improve overall survival in these patients. Our institutional experience demonstrated improved metastatic progression-free survival after a median follow-up of 32.1 months but did not show a survival benefit at short term follow-up. We evaluated the impact of local control on overall (OS) and disease-specific survival (DSS) in this population after a longer follow-up interval to determine if a survival benefit could be demonstrated from local surgical treatment for selected patients with stage IV breast cancer. Methods: We reviewed the records of all patients at our institution who presented from 1997–2002 with stage IV disease with an intact primary tumor. OS and DSS were estimated by the Kaplan-Meier method. The log-rank test was used to compare the difference in survival between surgical and non-surgical patients. Multivariate statistical analysis was performed using the Cox proportional hazards model. Results: Of 220 patients identified with stage IV disease with an intact primary tumor, 80 (36%) underwent surgical resection of the primary tumor; 39 (49%) had segmental mastectomy and 41 (51%) had a total mastectomy. There were 140 (64%) patients who did not undergo surgery. The median follow-up duration from time of presentation to our institution was 58.6 months and the median OS time after presentation was 45.8 months. After adjustment for covariates, surgery was associated with improved OS (p=0.03) and DSS (p=0.04) compared to the non-surgical group. Conclusions: With a median follow-up time of 58.6 months, patients who presented with stage IV breast cancer with an intact primary tumor treated surgically had significantly improved OS and DSS compared to patients who did not undergo surgery. Our findings may be limited by a selection bias. Therefore, we feel that the issue of surgical intervention for the primary tumor in stage IV breast cancer patients deserves to be carefully studied in a well-designed, prospective, multi-center trial. No significant financial relationships to disclose.

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Survival of de novo stage IV breast cancer patients over three decades

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-016-2306-1 ◽

2016 ◽

Vol 143 (3) ◽

pp. 509-519 ◽

Cited By ~ 16

Author(s):

Dieter Hölzel ◽

Renate Eckel ◽

Ingo Bauerfeind ◽

Bernd Baier ◽

Thomas Beck ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

De Novo ◽

Stage Iv ◽

Breast Cancer Patients ◽

Stage Iv Breast Cancer

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Change in neutrophil-lymphocyte ratio after initiation of chemotherapy can be a prognostic indicator in de novo stage IV breast cancer patients.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.70 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 70-70

Author(s):

Hae-Na Shin ◽

Jisun Kim ◽

Hee Jeong Kim ◽

Jong Won Lee ◽

Beom Seok Ko ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Palliative Chemotherapy ◽

De Novo ◽

Stage Iv ◽

Prognostic Indicator ◽

Breast Cancer Patients ◽

Lymphocyte Ratio ◽

Stage Iv Breast Cancer ◽

The Mean

70 Background: The de novo stage IV breast cancer has poor prognosis, predicting response to treatment in the affected patients is difficult. We investigated whether the initial neutrophil to lymphocyte ratio (NLR) at diagnosis and NLR change after the first palliative chemotherapy cycle can be a prognostic indicators. Methods: We retrospectively reviewed 218 de novo stage IV breast cancer patients with available NLR values who underwent palliative chemotherapy as an initial treatment. We analyzed cancer specific survival (CSS) according to initial NLR (iNLR), NLR change after the first chemotherapy cycle (ΔNLR), and a combination of these two. Results: The mean patient age was 47.2 years; the median follow-up period was 29.8 months. The mean iNLR and ΔNLR values were 2.83 ± 2.19 and 0.39 ± 3.74, retrospectively, amd were used as cut off points. There was no significant difference between low and high iNLR groups (p = 0.431); however, there was a significant correlation between ΔNLR and CSS (p = 0.031). The 1-, 3-, and 5- year CSS rates of patients in the increased ΔNLR group were significantly lower than those of patients in the stationary or decreased group. (78.4%, 35.4%, 20.8% vs 88.9%, 52.6%, 27.1%; p = 0.031). Multivariate analysis suggested that ΔNLR was an independent prognostic factor (hazard ratio (HR) = 1.748, 95% confidence interval (CI) = 1.084 - 2.818). The analysis of the combination of iNLR and ΔNLR showed that patients in the high iNLR and increased ΔNLR group had poorer prognosis than those in the low iNLR and stationary or decreased ΔNLR group (HR = 4.294, 95% CI = 1.586 - 11.629). Conclusions: Initial NLR alone was not a prognostic indicator among de novo stage IV breast cancer patients. However, patients with increased NLR after palliative chemotherapy exhibited worse CSS. Patients with high initial NLR and increased NLR after treatment might be a non responder to treatment.

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The eligibility of primary tumor resection for de novo stage IV breast cancer patients

Translational Cancer Research ◽

10.21037/tcr.2018.05.28 ◽

2018 ◽

Vol 7 (S5) ◽

pp. S604-S607 ◽

Cited By ~ 1

Author(s):

Tadahiko Shien

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Primary Tumor ◽

De Novo ◽

Tumor Resection ◽

Stage Iv ◽

Primary Tumor Resection ◽

Breast Cancer Patients ◽

Stage Iv Breast Cancer

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Local treatment of breast in de novo stage IV breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11526 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11526-e11526

Author(s):

Peng-Yu Chen ◽

Skye H Hong-Chun Cheng

Keyword(s):

Breast Cancer ◽

Liver Metastasis ◽

Cancer Patients ◽

Primary Tumor ◽

Primary Breast Cancer ◽

De Novo ◽

Local Treatment ◽

Stage Iv ◽

Breast Cancer Patients ◽

Stage Iv Breast Cancer

e11526 Background: Stage IV breast cancer is an incurable disease. Systemic therapy is usually the main treatment for these patients. Locoregional therapy, such as surgery or radiotherapy, is controversial. Recent studies suggested locoregional treatments of the primary breast cancer can provide some benefit for these patients. Methods: We conducted a chart review of de novo stage IV breast cancer patients at a cancer center hospital in TAIWAN from 1990 to 2008. A total of 276 patients were reviewed and 268 patients met the inclusion criteria. Tumor characteristics, anti-tumor treatments and survival were analyzed. Results: The median survival of 268 patients was 21.5 months. We divided these patients into two groups. There were 140 patients with less than 21.5 months of survival and 128 patients with more than 21.5 months of survival. In univariate analysis, infiltrating ductal carcinoma (p=0.002), ER-positive (p<0.0001), PR-positive (p<0.0001), and no overexpression of HER2 (p=0.0125) were associated with longer survival. The clinical primary tumor size (p=0.11) and positive axillary lymph node involvement (p=0.61) were not different significantly between two groups. About metastatic site, patients with liver mets (p<0.0001) and lung mets (p=0.025) were associated with shorter survival. Bone mets (p=0.63) was not associated with survival. Patients receiving local treatment of primary tumor, including surgery (p<0.0001) or locoregional radiation (p=0.0034), had longer survival. In multivariate analysis, patients who received surgery of primary breast cancer (HR=0.52, p=0.0006) or received systemic chemotherapy (HR=0.47, p=0.002) had better survival. In subgroup analysis, patients without liver metastasis who received surgery of primary breast cancer had longer overall survival significantly (p<0.0001). In contrast, surgery to the primary breast cancer had no benefit in survival (p=0.91) in patients with liver metastasis. Conclusions: Our institutional experience suggests locoregional treatment for primary breast cancer appear to be beneficial for de novo breast cancer patients, especially those without liver mets.

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