Skip to main content
Log in

Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

We have analyzed retrospectively 439 women with recurrent breast cancer, followed at a single institution, in order to define potential prognostic factors for survival at the time of first recurrence. Median age at the time of first recurrence was 58 and the median disease free interval (DFI) from initial diagnoses to recurrence was 33 months. Thirteen percent of the patients did not receive any adjuvant therapy while 87% received different combinations of chemotherapy, radiotherapy and hormone therapy as adjuvant treatment. With a median follow‐up of 44 months from the time of recurrence the median survival (MSR) was 24 months (SE 1.24) and five‐year overall survival was 18% (SE 2.02). On the univariate analysis, pathological tumor size (pT) at diagnosis (p<0.0006), axillary lymph node status at diagnosis (p<0.00001), negative estrogen receptor (ER) status (p<0.0001), negative progesterone receptor (PgR) status (p<0.0001), adjuvant chemotherapy (p<0.001), disease free interval (p<0.00001), location of recurrence (p<0.0002) and number of metastatic sites (≥3: p, ≤ 0.0003), were significantly associated with shorter survival from first relapse. On the multivariate analysis, only the site of recurrence, axillary lymph node status at diagnosis, ER status and DFI remained independently associated with decreased MSR after first relapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boring CC, Squires TS, Tong T, Montgomery S: Cancer statistics, 1994. CA Cancer J Clin 44: 7–26, 1994

    PubMed  Google Scholar 

  2. Brinton LA, Devesa SS: Etiology and pathogenesis of breast cancer. In: Harris JR, Lipman ME, Morrow M, Hellman S (eds), Diseases of the Breast. Lippincott-Raven, Philadelphia, 1996, pp. 159–306

    Google Scholar 

  3. Wingo PA, Tong T, Bolden S: Cancer statistics, 1995. CA Cancer J Clin 45: 8–30, 1995

    PubMed  Google Scholar 

  4. Valagussa P, Bonadonna G, Veronesi U: Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients. Cancer 41: 1170–1178, 1978

    PubMed  Google Scholar 

  5. Haagensen CD: Treatment of curable carcinoma of the breast. Int J Radiat Oncol Biol Phys 2: 975–980, 1977

    PubMed  Google Scholar 

  6. Sherry MM, Greco FA, Johnson DH, Hainsworth JD: Metastatic breast cancer confined to the skeletal system. An indolent disease. Am J Med 8 1: 381–386, 1986

    PubMed  Google Scholar 

  7. Sherry MM, Greco FA, Johnson DH, Hainsworth JD: Breast cancer with skeletal metastases at initial diagnosis. Distinctive clinical characteristics and favorable prognosis. Cancer 58: 178–182, 1986

    PubMed  Google Scholar 

  8. Inoue K, Ogawa M, Horikoshi N, Aiba K, Mukaiyama T, Mizunuma N, Itami S, Hirano A, Matsuoka A, Matsumura T: Evaluation of prognostic factors for 233 patients with recurrent advanced breast cancer. Jpn J Clin Oncol 21: 334–339, 1991

    PubMed  Google Scholar 

  9. Paterson AH, Zuck VP, Szafran O, Lees AW, Hanson J: Influence and significance of certain prognostic factors on survival in breast cancer. Eur J Clin Oncol 18: 937–943, 1982

    Google Scholar 

  10. Perez JE, Machiavelli M, Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Rodriguez R, Cuevas MA, Alvarez LA: Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Grupo Oncologico Cooperativo del Sur. Am J Clin Oncof 13: 294–298, 1990

    Google Scholar 

  11. Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Perez JE, Machiavelli M, Rodriguez R, Alvarez LA: Stage IV breast cancer: clinical course and survival of patients with osseous versus extraosseous metastases at initial diagnosis. The GOCS (Grupo Oncologico Cooperativo del Sur) experience. Am J Clin Oncol 11: 618–622, 1988

    PubMed  Google Scholar 

  12. Koenders PG, Beex LV, Kloppenborg PW, Smals AG, Benraad TJ: Human breast cancer: survival from first metastasis. Breast Cancer Study Group. Breast Cancer Res Treat 21: 173–180, 1992

    PubMed  Google Scholar 

  13. Clark GM, Sledge GWJ, Osborne CK, McGuire WL: Survival from first recurrence: relative importance of prognostic factors in 1015 breast cancer patients. J Clin Oncol 5: 55–61, 1987

    PubMed  Google Scholar 

  14. Vogel CL, Azevedo S, Hilsenbeck S, East DR, Ayub J: Survival after first recurrence of breast cancer. The Miami experience. Cancer 70: 129–135, 1992

    PubMed  Google Scholar 

  15. Hortobagyi GN, Smith TL, Legha SS, Swenerton KD, Gehan EA, Yap HY, Buzdar AU, Blumenschein GR:Multivariate analysis of prognostic factors in metastatic breast cancer. J Clin Oncol 1: 776–786, 1983

    PubMed  Google Scholar 

  16. Howell A, Barnes DM, Harland RN, Redford J, Bramwell VH, Wilkinson MJ, Swindell R, Crowther D, Sellwood RA: Steroid-hormone receptors and survival after first relapse in breast cancer. Lancet 17: 588–591, 1984

    Google Scholar 

  17. Yamashita K, Koyama H, Inaji H: Prognostic significance of bone metastasis from breast cancer. Clin Orthop 312: 89–94, 1995

    PubMed  Google Scholar 

  18. Kiricuta IC, Willner J, Kolbl O, Bohndorf W: The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys 28: 387–393, 1994

    PubMed  Google Scholar 

  19. Goldhirsch A, Gelber RD, Castiglione M: Relapse of breast cancer after adjuvant treatment in premenopausal and perimenopausal women: patterns and prognoses. J Clin Oncol 6: 89–97, 1988

    PubMed  Google Scholar 

  20. Bland JM, Altman DG: Survival probabilities (the Kaplan-Meier method). BMJ 317: 1572, 1998

    PubMed  Google Scholar 

  21. Cox DR: Regression models and life tables. JR Stat Soc B34: 187–220, 1972

    Google Scholar 

  22. von Maillot K, Horke W, Prestele H: Prognostic significance of the steroid receptor content in primary breast cancer. Arch Gynecol 231: 185–190, 1982

    PubMed  Google Scholar 

  23. Barbi GP, Marroni P, Bruzzi P, Nicolo G, Paganuzzi M, Ferrara GB: Correlation between steroid hormone receptors and prognostic factors in human breast cancer. Oncology 44: 265–269, 1987

    PubMed  Google Scholar 

  24. Garcia M, Derocq D, Freiss G, Rochefort H: Activation of estrogen receptor transfected into a receptor-negative breast cancer cell line decreases the metastatic and invasive potential of the cells. Proc Natl Acad Sci USA 89: 11538–11542, 1992

    PubMed  Google Scholar 

  25. Singhakowinta A, Potter HG, Buroker TR, Samal B, Brooks SC, Vaitkevicius VK: Estrogen receptor and natural course of breast cancer. Ann Surg 183: 84–88, 1976

    PubMed  Google Scholar 

  26. Lionetto R, Pronzato P, Bertelli GF, Ardizzoni A, Conte PF, Rosso R: Survival of patients with relapsing breast cancer: analysis of 302 patients. Oncology 43: 278–282, 1986

    PubMed  Google Scholar 

  27. Swenerton KD, Legha SS, Smith T, Hortobagyi GN, Gehan EA, Yap HY, Gutterman JU, Blumenschein GR: Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res 39: 1552–1562, 1979

    PubMed  Google Scholar 

  28. Kocher M, Muller RP, Staar S, Degroot D: Long-term survival after brain metastases in breast cancer. Strahlenther Onkol 171: 290–295, 1995

    PubMed  Google Scholar 

  29. Fisher ER, Sass R, Fisher B: Pathologic findings from the National Surgical Adjuvant Project for Breast Cancers (protocol no. 4). X. Discriminants for tenth year treatment failure. Cancer 53: 712–723, 1984

    PubMed  Google Scholar 

  30. Alexieva-Figusch J, Van Putten WL, Blankenstein MA, Blonk-Van Der Wijst J, Klijn JG: The prognostic value and relationships of patient characteristics, estrogen and progestin receptors, and site of relapse in primary breast cancer. Cancer 61: 758–768, 1988

    PubMed  Google Scholar 

  31. Shek LL, Godolphin W: Model for breast cancer survival: relative prognostic roles of axillary nodal status, TNM stage, estrogen receptor concentration, and tumor necrosis. Cancer Res 48: 5565–5569, 1988

    PubMed  Google Scholar 

  32. Hahnel R, Woodings T, Vivian AB: Prognostic value of estrogen receptors in primary breast cancer. Cancer 44: 671–675, 1979

    PubMed  Google Scholar 

  33. Howat JM, Harris M, Swindell R, Barnes DM: The effect of oestrogen and progesterone receptors on recurrence and survival in patients with carcinoma of the breast. Br J Cancer 51: 263–270, 1985

    PubMed  Google Scholar 

  34. Kamby C, Rasmussen BB, Kristensen B: Oestrogen receptor status of primary breast carcinomas and their metastases. Relation to pattern of spread and survival after recurrence. Br J Cancer 60: 252–257, 1989

    PubMed  Google Scholar 

  35. Rabinovich M, Vallejo C, Bianco A, Perez J, Machiavelli M, Leone B, Romero A, Rodriguez R, Cuevas M, Dansky C, Xynos F, Alvarez L: Development and validation of prognostic models in metastatic breast cancer: a GOCS study. Oncology 49: 188–195, 1992

    PubMed  Google Scholar 

  36. Falkson G, Holcroft C, Gelman RS, Tormey DC, Wolter JM, Cummings FJ: Ten-year follow-up study of premenopausal women with metastatic breast cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol 13: 1453–1458, 1995

    PubMed  Google Scholar 

  37. Goldhirsch A, Wood WC, Senn HJ, Glick JH, Gelber RD: Meeting highlights: international consensus panel on the treatment of primary breast cancer. J Natl Cancer Inst 87: 1441–1445, 1995

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Insa, A., Lluch, A., Prosper, F. et al. Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat 56, 67–78 (1999). https://doi.org/10.1023/A:1006285726561

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006285726561

Navigation