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Breast Cancer Res Treat. 2017 Aug;165(1):109-118. doi: 10.1007/s10549-017-4309-2. Epub 2017 Jun 1.

Identifying long-term survivors among metastatic breast cancer patients undergoing primary tumor surgery.

Author information

1
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
2
Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
3
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. bjchae@gmail.com.
4
Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. bjchae@gmail.com.
5
Department of Surgery, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
6
Department of Surgery, Haeundae-Paik Hospital, College of Medicine, Inje University, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
7
Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
8
Department of Surgery, Yeungnam University Hospital, 170 Hyungchoong-ro, Nam-gu, Daegu, 42415, Republic of Korea.
9
Department of Breast and Thyroid Surgery, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea.
10
Department of Breast Surgery, Gil Medical Center, Gachon University, 21 Namgong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
11
Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon, 14647, Republic of Korea.

Abstract

PURPOSE:

The prognostic role of primary tumor surgery in women with metastatic breast cancer at diagnosis is contentious. A subset of patients who will benefit from aggressive local treatment is needed to be identified. Using a nationwide database, we developed and validated a predictive model to identify long-term survivors among patients who had undergone primary tumor surgery.

METHODS:

A total of 150,043 patients were enrolled in the Korean Breast Cancer Registry between January 1990 and December 2014. Of these, 2332 (1.6%) presented with distant metastasis at diagnosis. Using Cox proportional hazards regression, we developed and validated a model that predicts survival in patients who undergo primary tumor surgery, based on the clinicopathological features of the primary tumor.

RESULTS:

A total of 2232 metastatic breast cancer patients were reviewed. Of these, 1541 (69.0%) patients had undergone primary tumor surgery. The 3-year survival rate was 62.6% in this subgroup. Among these patients, advanced T-stage, high-grade tumor, lymphovascular invasion, negative estrogen receptor status, high Ki-67 expression, and abnormal CA 15-3 and alkaline phosphatase levels were associated with poor survival. A prediction model was developed based on these factors, which successfully identified patients with remarkable survival (score 0-3, 3-year survival rate 87.3%). The clinical significance of the model was also validated with an independent dataset.

CONCLUSIONS:

We have developed a predictive model to identify long-term survivors among women who undergo primary tumor surgery. This model will provide guidance to patients and physicians when considering surgery as a treatment modality for metastatic breast cancer.

PMID:
28573447
DOI:
10.1007/s10549-017-4309-2
[Indexed for MEDLINE]

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