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Evaluation of Prognostic Factors In Patients with Metastatic Breast Cancer

Shahid Beheshti University of Medical Sciences
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  • Biology
  • Medicine


AbstractPurpose: Metastatic breast cancer has remained as an incurable disease. The mainobjectives of treatments include alleviating of symptoms, delaying diseaseprogression and increasing survival without any adverse effect on the quality of life.The main purpose of this study was to investigate the effects of someclinocopathological factors on the survival of patients with metastatic breastcarcinoma in our institute.Patients and Methods: In this retrospective cohort study, we reviewed the files ofpatients who were metastatic at presentation or became metastatic during follow-upand were referred to oncology department of Omid Hospital affiliated to MashhadUniversity of Medical Sciences from 1997 to 2007. The information regardingclinicopathological characteristics were recorded. The first line chemotherapyregimen was as follows: 79 CAF (cyclophosphamide, doxurobicine, 5FU), 25 CMF(cyclophosphamide, methotrexate, 5FU) and 11 Taxene based; AT (doxorubicin,paclitaxol) or TAC (taxene, doxurobicine, cyclophosphamide).Results: 115 patients with a median age of 45 (range, 25-78) were investigated.The median follow-up time for all patients from diagnosis was 21 months (range, 5-74 months) and from metastatic manifestation was 12 months (5-36 months). The sitesof recurrence or metastasis were as follows: 18 (15.7%) local recurrence, 23(20%)bone and 74 (64.3%) visceral metastases. The median and 2- year overall survivalfor all patients with metastatic disease were 15 months and 44.6% ± 6%respectively. Patients with bone metastasis had a significantly better overall survivalcompared to those with visceral metastasis. (74.2%vs.36.1%, P= 0.04) Among thosepatients who were non-metastatic at the time of referral, the time left to metastasishad a significant effect on the overall survival from metastasis manifestation. Incomparison with premenopausal patients, the overall survival was relatively better inpostmenopausal cases. (59.4% vs. 38.5%, P=0.1)Conclusion: In our study, disease free survival (DFS) was the most important factorfor overall survival in patients with metastatic breast cancer. The patients with longerDFS (>18month) had better overall survival. Overall the patients with bonemetastasis had better survival than visceral metastasis.Keywords: prognostic factors, metastatic breast cancer, disease free survivalReferences1. Wood WC, Muss HB, Solin LJ, Olopade OI. Malignanttumors of the breast, In: DeVita VT,Cancer Principle andPractice.7th Edition, Philadelphia, Lippincott Williams andWilkins 2005:1453-572. Oshaughnessy J. Extending survival with chemotherapyin metastatic breast cancer. Oncologist, 2005; 10 suppl3:20-93. Sherry M.M, Greco F.A, Johnson D.H, Hainsworth J.D.Metastatic breast cancer confined to the skeletal system. Anindolent disease, Am. J. Med. 81 1986; 3: 381–386.4. Koizumi M, Yoshimoto M, Kasumi F , Ogata E.Comparison between solitary and multiple skeletal metastaticlesions of breast cancer patients, Ann. Oncol. 14, 2003, 8,1234–1240.5. Fossati R, Confalonieri C, Torri V, Gnislandi E, Penna A, Pistotti V, et al. Cytotoxic and hormonal treatment formetastatic breast cancer: a systematic review of publishedrandomized trials involving 31,510 women, J. Clin. Oncol.1998;16: 3439–3460.6. Chia S.K.L, Speers C, Kang A, D’Yachova Y, MalfairTaylor S, Barnett J et al. The impact of newchemotherapeutic and hormonal agents on the survival ofwomen with metastatic breast cancer (MBC) in a populationbased cohort. Proc. ASCO Meeting Proceedings Chicago.2003: 89.7. Yamamoto N, Watanabe T, Katsumata N, Omuro Y,Ando M , Fukuda H et al. Construction and validation of apractical prognostic index for patients with metastatic breastcancer, J. Clin. Oncol. 1998;16( 7):2401–2408.8. Ezzat A, Raja M.A, Zwaan F, Brigden M, Rostom A,Bazarbashi S. The lack of age as a significant prognosticfactor in nonmetastatic breast cancer, European Journal ofSurgical Oncology, February 1998;24(1): 23-279. Del Mastro L, Venturini M, Garrone O, Bruzzi P,Bertelli G, Bergaglio M. Effect of previous adjuvantchemotherapy on the activity and efficacy of CEF regimen inmetastatic breast cancer patients. European Journal ofCancer , 1996: 18.

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