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Identifying long-term survivors among metastatic breast cancer patients undergoing primary tumor surgery

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Abstract

Purpose

The prognostic role of primary tumor surgery in women with metastatic breast cancer at diagnosis is contentious. A subset of patients who will benefit from aggressive local treatment is needed to be identified. Using a nationwide database, we developed and validated a predictive model to identify long-term survivors among patients who had undergone primary tumor surgery.

Methods

A total of 150,043 patients were enrolled in the Korean Breast Cancer Registry between January 1990 and December 2014. Of these, 2332 (1.6%) presented with distant metastasis at diagnosis. Using Cox proportional hazards regression, we developed and validated a model that predicts survival in patients who undergo primary tumor surgery, based on the clinicopathological features of the primary tumor.

Results

A total of 2232 metastatic breast cancer patients were reviewed. Of these, 1541 (69.0%) patients had undergone primary tumor surgery. The 3-year survival rate was 62.6% in this subgroup. Among these patients, advanced T-stage, high-grade tumor, lymphovascular invasion, negative estrogen receptor status, high Ki-67 expression, and abnormal CA 15-3 and alkaline phosphatase levels were associated with poor survival. A prediction model was developed based on these factors, which successfully identified patients with remarkable survival (score 0–3, 3-year survival rate 87.3%). The clinical significance of the model was also validated with an independent dataset.

Conclusions

We have developed a predictive model to identify long-term survivors among women who undergo primary tumor surgery. This model will provide guidance to patients and physicians when considering surgery as a treatment modality for metastatic breast cancer.

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Acknowledgements

This study was supported by the Korean Breast Cancer Society.

Author information

Authors and Affiliations

  1. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Tae-Kyung Yoo, Byung Joo Chae, Yong Hwa Eom, Hyung Suk Kim, Chang Jong Kim, Man sik Shin & Sun Hyong You

  2. Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Tae-Kyung Yoo, Byung Joo Chae & Yong Hwa Eom

  3. Department of Surgery, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea

    Sei Joong Kim

  4. Department of Surgery, Haeundae-Paik Hospital, College of Medicine, Inje University, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea

    JungSun Lee

  5. Division of Breast and Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Tae In Yoon

  6. Department of Surgery, Yeungnam University Hospital, 170 Hyungchoong-ro, Nam-gu, Daegu, 42415, Republic of Korea

    Soo Jung Lee

  7. Department of Breast and Thyroid Surgery, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea

    Ho Yong Park

  8. Department of Breast Surgery, Gil Medical Center, Gachon University, 21 Namgong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Heung Kyu Park

  9. Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon, 14647, Republic of Korea

    Byung Joo Song

Authors
  1. Tae-Kyung Yoo
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  2. Byung Joo Chae
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  5. Tae In Yoon
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  10. Hyung Suk Kim
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  11. Chang Jong Kim
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  12. Man sik Shin
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  13. Sun Hyong You
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  14. Byung Joo Song
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Correspondence to Byung Joo Chae.

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Yoo, TK., Chae, B.J., Kim, S.J. et al. Identifying long-term survivors among metastatic breast cancer patients undergoing primary tumor surgery. Breast Cancer Res Treat 165, 109–118 (2017). https://doi.org/10.1007/s10549-017-4309-2

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  • DOI: https://doi.org/10.1007/s10549-017-4309-2

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