Survival After Metastases May Be Predicted In Breast Cancer Patients

A post-metastases overall survival score has been devised for patients with breast cancer

medwireNews: South Korean researchers have identified six key factors that combine together to estimate the likelihood of long-term survival in breast cancer patients with metastatic disease.

“Based on our observations, we have constructed a prediction model that can help patients to obtain more clear insights into their future outcomes and can also guide the physicians to select personalized treatment options for individual metastatic breast cancer patients”, the team reports in the Annals of Oncology.

Hyeong-Gon Moon, from Seoul National University College of Medicine, and co-workers collated information from 547 patients who had undergone curative surgery but subsequently developed distant disease a median of 29 months later. The patients had a median post-metastasis overall survival (PMOS) of 31 months.

COX proportional regression analysis showed that a shorter PMOS was significantly associated with primary tumour characteristics such as advanced tumour stage, hormone receptor-negative status and a high Ki-67 level. Poor PMOS was also significantly predicted by a shorter disease-free interval, brain metastases or distant disease to multiple sites, and symptomatic metastases.

These factors were then used to create a PMOS score to estimate long-term survival after distant metastases, where a score of 0–1 had the longest survival and a score of 6–8 the shortest. When this was applied to the patients, the median survival for these categories was 71 months and 12 months, respectively.

The researchers validated the PMOS score in a second group of 254 breast cancer patients and found that rising score significantly correlated with shorter survival.

They emphasize that the PMOS scores were “highly reproducible” for patients with a score of 4–5 and 6–8 in the development and validation cohorts.

“Based on our model, we propose that these patients are unlikely to benefit from intensive multidisciplinary therapy aimed at clinical remission since their disease may progress rapidly”, comment Hyeong-Gon Moon et al.

The researchers note that there was an inverse association between the prognostic characteristics and PMOS. But the correlation was only significant for initial tumour size and survival in patients who developed distant disease within 3 years.

“Advanced tumors with a higher burden of disseminated tumor cells often carry micro-metastastic foci in multiple organs”, the authors observe.

“Therefore, distant metastasis in patients with initially advanced diseases may mimic the behavior of the tumors with multiple site metastasis.

“The risk of having occult metastases at multiple organs might be low in patients who develop metastasis many years after the initial treatment.

References

Lee ES, Jung SY, Kim JY, et al. Identifying the potential long-term survivors among breast cancer patients with distant metastasis. Ann Oncol 2016; Advance online publication 28 January. doi: 10.1093/annonc/mdw036

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