Impact of Intensive Follow-up for Bone Metastasis on Characteristics and Prognosis of Chinese Breast Cancer Patients

e13072 Background: Bone Metastases (BM) are still the main cause of morbidity and morbility in cancer patients because of their complications defined as skeletal-related events (SREs).SREs reduce pts quality of life and are associated with an increasing in social and health costs. At present, data concerning BM are mainly obtained retrospectively from monocentric experiences. Methods: We performed a multicentre prospective observational study of patients with BM from breast cancer (BC) with at least 6 month (m)'s follow-up who were registered in a prospective BM database (BMDB). Detailed information on patients at first diagnosis of BM was recorded in a custom-built software system, updated every 6 m by participating centres and reviewed by the coordinator centre.All pts have signed an informed consent. Results: Since October 2014,618 pts with BM from solid tumors were enrolled of whom 220 have BC as primitive site with a 6 m follow-up. Median age was 62 y (range 26-86). Median Follow up was 34 m (6-149). At enrolment 109 (50%) had only BM and 109 (50%) pts had concomitant visceral and BM. Median time to first BM was 47 m (range 0-312) in Bone only disease and 78.6 m in pts with visceral bone metastases. Disease Free interval (DFI) was different according to BC molecular subtypes and stage. The univariate hazard ratio (HR) for visceral or bone metastasis was higher in luminal B tumors (1.56, 95% confidence interval [CI]:1.1-2.3) (p = 0.002), basal-like (2.50, 95% CI:1.1-6.0) (p = 0.043), and HER2-enriched tumors (1.37, 95% CI:0.78-2.4) (p = 0.273). DFI for pts with stage I disease at diagnosis of primary BC was longer than that for stage III pts (median 67.2 m, 95%CI:53.1-96.1, vs. 58.1 m, 95%CI:41.9-73.4), with a HR of 1.84 (95% CI:1.1-3.0) (p = 0.015) for the stage III group, and 0.98 (95% C.I.:0.6-1.5) (p = 0.930) for the stage II group. During BM disease, 98 pts had at least 1 SREs . Zoledronate was used in 69.1% and Denosumab in 28.3% of cases. First line treatment was hormone-based (n = 105, 50.7%) chemo-based therapy (n = 80, 38.7%) and chemo+ormono based (n = 20, 9.7%). During follow up progression disease occurred in 167 pts. Median progression-free (mPFS) and overall survival calculated from metastatic disease diagnosis (mOS) were 15.1 m (95%CI 12.6-18.4) and 66.8 m (95%CI 52.1-79.2),respectively. Conclusions: This study presents prospective data about a cohort of BC pts enrolled at the first BM occurrence and followed over the time, extrapolated by the multicentric observational BMDB in order to better understed the clinical history of breast cancer and bone metastases.

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Prognostic significance of plasma osteopontin level in breast cancer patients

Forum of Clinical Oncology ◽

10.1515/fco-2015-0005 ◽

2015 ◽

Vol 6 (1) ◽

pp. 27-32

Author(s):

Hanan R. Nassar ◽

Alfred E. Namour ◽

Hanan E. Shafik ◽

Amr S. El Sayed ◽

Samar M. Kamel ◽

...

Keyword(s):

Breast Cancer ◽

Bone Metastasis ◽

Cancer Patients ◽

Biochemical Marker ◽

Menopausal Status ◽

P Value ◽

Breast Cancer Patients ◽

Pathological Type ◽

Significant Difference

Abstract Many studies have demonstrated that osteopontin (OPN) contributes functionally to aggressive behaviour in many tumours including breast cancer. This study aims to investigate its role as a simple biochemical marker easily measured in plasma of breast cancer patients to give an early signal for metastases and to detect its relationship to clinicopathological findings and survival. We measured plasma OPN, CA15.3 and serum alkaline phosphatase (ALP) activity in 55 patients, 28 with early stage breast cancer and 27 with bone metastasis out of whom 20 had metastasis in other sites. The median age at diagnosis for non-metastatic cases was 60 years (range 35-85) and for metastatic cases was 45.5 years (range 32-59). In the non-metastatic group, 78.57% of the patients were histologically graded as grades I and II and 21.43% as grade III tumours. In the metastatic group, 81.48% of the patients had grades I and II and 18.52% had grade III tumours; 54% of patients in the non-metastatic group were at stage II and 46% were at stage III at presentation. All patients of group II had bone metastasis, 33% had liver metastases, 25.9% had lung metastasis and 14.8% had lymph node metastasis. Patients with non-metastatic disease had a median OPN level of 55 ng/ml (range 54-150 ng/l), while those in the metastatic group had a median of 148.0 ng/l (range 56.0-156.0 ng/l), a difference which was statistically significant (P = 0.001). There was no statistically significant difference in the median levels of CA15.3 and ALP between both groups. The median OPN level was significantly higher with serum ALP level above 90, progesterone receptor (PR) status, bone and visceral metastasis. Median OPN was not affected significantly by menopausal status (P-value 0.3), tumour grade (P-value 0.3), estrogen receptor (ER) status (P-value 0.7), pathological type (P-value 0.42) or serum CA15.3 level (P-value 0.6). At the end of 12-year follow-up, 83% of the patients survived (92.3% in the non-metastatic versus 74.1% in the metastatic group). The estimated median survival for the whole study population at 12 years was 13 years (95% CI 8.144-17.856). The estimated median survival was 13 years (95% CI 0) and 12 years (95% CI 4.893-19.11) in patients with median OPN levels of <142 and ≥142, respectively, a difference which was not statistically significant (P = 0.343). No statistically significant difference in overall survival OS was noticed in relation to menopausal status (P = 0.7), pathological type (P = 0.4) and hormone receptor status (P = 0.3). At 6-year follow-up, it was found that OS was affected by the presence of visceral metastasis, tumour grade, serum plasma level of ALP and the serum level of CA15.3 (P = 0.0006, 0.007, 0.001 and 0.03, respectively). However, the presence of bone metastasis did not affect OS (P = 0.6). Osteopontin level can be a simple biochemical marker easily measured in plasma of breast cancer patients to give early signals for metastases, but not a prognostic factor for survival.

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Reduced risk of metastatic breast cancer recurrence after bone fractures

10.21203/rs.3.rs-103474/v1 ◽

2020 ◽

Author(s):

Nadia Obi ◽

Stefan Werner ◽

Frank Thelen ◽

Klaus Pantel

Keyword(s):

Breast Cancer ◽

Bone Metastasis ◽

Cancer Patients ◽

Bone Fractures ◽

Cancer Recurrence ◽

Breast Cancer Recurrence ◽

Insurance Fund ◽

Breast Cancer Patients ◽

Positive Effects

Abstract Recent experimental studies indicate that bone fractures result in the release of cytokines and cells that promote metastasis. Obtaining observational data on bone fractures after breast cancer diagnosis related to distant breast cancer recurrence risk could help determine whether fall prevention strategies can contribute to reduce breast cancer mortality. We used data from the largest German statutory health insurance fund (Techniker Krankenkasse) in a population-based cohort study of breast cancer patients diagnosed between January 2015 and November 2019. ICD-10 codes were documented monthly to quarterly. Fractures diagnosed simultaneous or after the initial breast cancer and metastases diagnosed initially from half a year later on served as exposure and outcome, respectively. The risk of regional, distant non-bone or bone metastasis related to a fracture was modelled by adjusted conditional logistic regression analysis. Of 154,000 breast cancer patients, 82,039 had a follow-up time of more than half a year. During follow-up, fractures were diagnosed in 11,900 (14.5%) patients and regional or distant metastases occurred in 7,011 (8.5%). The risk for a metastasis was reduced in patients, who had a fracture (OR 0.57, 95% CI 0.53, 0.62) compared to patients without, particularly for lymph node metastasis and moderately less pronounced in bone-metastasis (OR 0.69, 95% CI 0.61, 0.79). In view of the positive effects of sports on health of cancer survivors, the present results will decrease the anxiety of breast cancer patients that risking bone fractures might have a negative impact on their disease-specific outcome.

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Genetic Counseling in the Follow-up of Breast Cancer patients; Conversion of a Luminal Tumor to TNBC

Archives of Breast Cancer ◽

10.32768/abc.20207110-13 ◽

2020 ◽

pp. 10-13

Author(s):

Hamid Ahmadi ◽

Reza Hosseinpour ◽

Behnaz Jahanbin ◽

Keivan Majidzadeh-A ◽

Farid Azmoudeh-Ardalan

Keyword(s):

Breast Cancer ◽

Genetic Counseling ◽

Bone Metastasis ◽

Cancer Patients ◽

Triple Negative ◽

Brca Mutation ◽

Luminal Breast Cancer ◽

Breast Cancer Patients ◽

Triple Negative Subtype

Background: Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial. Case presentation: A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences.Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors?Conclusion: There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Re-assessing the specimen for ER, PR, and HER-2 is necessary for this setting.

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