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Survival of patients with metastatic breast carcinoma
Author(s) -
Chang Jenny,
Clark Gary M.,
Allred D. Craig,
Mohsin Syed,
Chamness Gary,
Elledge Richard M.
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11083
Subject(s) - medicine , breast cancer , breast carcinoma , oncology , lymph node , univariate analysis , primary tumor , carcinoma , axillary lymph nodes , estrogen receptor , lymph , pathology , cancer , metastasis , multivariate analysis
BACKGROUND Women with metastatic breast carcinoma have a highly variable clinical course and outcome. Intrinsic genetic heterogeneity of the primary breast tumor may play a role in this variability and may explain it in part. Therefore, the authors tested the hypothesis that the characteristics of primary breast tumors are important determinants of prognosis and survival in patients with metastatic breast carcinoma. METHODS The prognostic significance of the biology of the primary tumor for outcome in patients with metastatic breast disease was assessed in 346 patients with lymph node positive breast carcinoma who developed distant, recurrent disease. Traditional prognostic indicators (age, tumor size, number of involved lymph nodes, sites of recurrence, disease free interval [DFI], adjuvant treatments, estrogen receptor [ER] expression, progesterone receptor [PgR] expression, S‐phase fraction [SPF], and DNA ploidy), together with three newer biologic markers (c‐ erb B‐2, p53, and bcl‐2) were assessed. Sites of recurrence were defined as nonvisceral (bone and locoregional lymph nodes) or visceral (lung, liver, brain, and other organs). RESULTS The median duration of survival was 17.8 months (95% confidence interval, 15.2–21.5 months). Univariate analysis showed that age > 50 years, visceral disease, and shorter DFI were associated significantly with poor outcome ( P < 0.05). In addition, the molecular phenotype of the primary breast tumor was significant, with primary tumors that showed ER negativity and PgR negativity, high SPF, aneuploidy, accumulation of p53 protein, and lower bcl‐2 expression, together with c‐ erb B‐2 overexpression, all associated with a poorer clinical outcome ( P < 0.05). In a multivariate analysis, older age, visceral disease, shorter DFI, PgR negativity, high SPF, and lower bcl‐2 expression were significant predictors of worse survival ( P < 0.05). CONCLUSIONS In addition to traditional risk factors, bcl‐2 negativity was associated significantly with a worse clinical outcome. Biologic features of primary tumors were correlated independently with outcome after first recurrence in patients with metastatic breast carcinoma and may be used as indicators of prognosis in the metastatic setting. Cancer 2003;97:545–53. © 2003 American Cancer Society. DOI 10.1002/cncr.11083