Newly diagnosed stage IV breast cancer: Clinicopathological features and prognosis of 65 patients / 肿瘤

ABSTRACT

Objective: To investigate the clinicopathologic characteristics, treatment and related prognostic factors of patients with newly diagnosed stage IV breast cancer. Methods: The clinicopathologic features, treatment and prognosis of 65 patients with newly diagnosed stage IV breast cancer admitted in Tianjin Medical University Cancer Institute and Hospital between January 2005 and November 2014 were retrospectively analyzed. Univariate and multivariate analyses of related factors of prognosis were examined. Results: The median age at diagnosis of stage IV breast cancer in 65 patients was 53 years (range 25-82 years); invasive ductal carcinoma and invasive carcinoma were the most common pathologic types; the tumor size was staged T4 in 49.2% of all the patients. Immunohistochemical results showed that the hormone receptor was positive in 66.2% of the patients (43/65), human epidermal growth factor receptor-2 (HER-2) was positive in 29.2% of the patients (19/65), and Ki-67 index was 20% or less in 23.1% of the patients (15/65). The initial treatment was systemic rescue chemotherapy, accounting for 92.3% (60/65); the remaining 5 patients underwent surgery for primary breast cancer before systemic rescue chemotherapy. During the period of follow-up, total of 21 patients underwent surgery for the primary breast cancer. The median progression-free survival (PFS) time and median survival time after diagnosis were 8.9 months and 31.8 months, respectively. HER-2 expression and site of first metastasis were independent factors for PFS (P < 0.05). Ki-67 index and brain metastasis during follow-up were independent factors for overall survival (OS) (P < 0.05). Conclusion: The primary tumor size of stage IV breast cancer at initial diagnosis is generally larger, however the prognosis is mainly related to the expression of HER-2, Ki-67 index and the sites of distant metastases. Systemic rescue chemotherapy is the main treatment for stage IV breast cancer patients, then the surgery of primary breast cancer could be considered on the basis of systemic rescue chemotherapy.