Evaluation of Prognostic Factors In Patients with Metastatic Breast Cancer

Purpose: Metastatic breast cancer has remained as an incurable disease. The main objectives of treatments include alleviating of symptoms, delaying disease progression and increasing survival without any adverse effect on the quality of life. The main purpose of this study was to investigate the effects of some clinocopathological factors on the survival of patients with metastatic breast carcinoma in our institute.

Patients and Methods: In this retrospective cohort study, we reviewed the files of patients who were metastatic at presentation or became metastatic during follow-up and were referred to oncology department of Omid Hospital affiliated to Mashhad University of Medical Sciences from 1997 to 2007. The information regarding clinicopathological characteristics were recorded. The first line chemotherapy regimen 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 sites of 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 survival for all patients with metastatic disease were 15 months and 44.6% ± 6% respectively. Patients with bone metastasis had a significantly better overall survival compared to those with visceral metastasis. (74.2%vs.36.1%, P= 0.04) Among those patients who were non-metastatic at the time of referral, the time left to metastasis had a significant effect on the overall survival from metastasis manifestation. In comparison with premenopausal patients, the overall survival was relatively better in postmenopausal cases. (59.4% vs. 38.5%, P=0.1)

Conclusion: In our study, disease free survival (DFS) was the most important factor for overall survival in patients with metastatic breast cancer. The patients with longer DFS (>18month) had better overall survival. Overall the patients with bone metastasis had better survival than visceral metastasis.