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Plichta JK, Thomas SM, Wang X, McDuff SGR, Kimmick G, Hwang ES. Survival among patients with untreated metastatic breast cancer: "What if I do nothing?". Breast Cancer Res Treat 2024; 205:333-347. [PMID: 38438700 PMCID: PMC11102301 DOI: 10.1007/s10549-024-07265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE We sought to assess survival outcomes of patients with de novo metastatic breast cancer (dnMBC) who did not receive treatment irrespective of the reason. METHODS Adults with dnMBC were selected from the NCDB (2010-2016) and stratified based on receipt of treatment (treated = received at least one treatment and untreated = received no treatments). Overall survival (OS) was estimated using the Kaplan-Meier method, and groups were compared. Cox proportional hazards models were used to identify factors associated with OS. RESULTS Of the 53,240 patients with dnMBC, 92.1% received at least one treatment (treated), and 7.9% had no documented treatments, irrespective of the reason (untreated). Untreated patients were more likely to be older (median 68 y vs 61 y, p < 0.001), have higher comorbidity scores (p < 0.001), have triple-negative disease (17.8% vs 12.6%), and a higher disease burden (≥ 2 metastatic sites: 38.2% untreated vs 29.2% treated, p < 0.001). The median unadjusted OS in the untreated subgroup was 2.5 mo versus 36.4 mo in the treated subgroup (p < 0.001). After adjustment, variables associated with a worse OS in the untreated cohort included older age, higher comorbidity scores, higher tumor grade, and triple-negative (vs HR + /HER2-) subtype (all p < 0.05), while the number of metastatic sites was not associated with survival. CONCLUSIONS Patients with dnMBC who do not receive treatment are more likely to be older, present with comorbid conditions, and have clinically aggressive disease. Similar to those who do receive treatment, survival in an untreated population is associated with select patient and disease characteristics. However, the prognosis for untreated dnMBC is dismal.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Xuanji Wang
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Susan G R McDuff
- Duke Cancer Institute, Durham, NC, USA
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Gretchen Kimmick
- Duke Cancer Institute, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA
- Duke Cancer Institute, Durham, NC, USA
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Glotzbach A, Rohlf K, Gonscharow A, Lüke S, Demirci Ö, Begher-Tibbe B, Overbeck N, Reinders J, Cadenas C, Hengstler JG, Edlund K, Marchan R. EDI3 knockdown in ER-HER2+ breast cancer cells reduces tumor burden and improves survival in two mouse models of experimental metastasis. Breast Cancer Res 2024; 26:87. [PMID: 38816770 PMCID: PMC11138102 DOI: 10.1186/s13058-024-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Despite progress understanding the mechanisms underlying tumor spread, metastasis remains a clinical challenge. We identified the choline-producing glycerophosphodiesterase, EDI3 and reported its association with metastasis-free survival in endometrial cancer. We also observed that silencing EDI3 slowed cell migration and other cancer-relevant phenotypes in vitro. Recent work demonstrated high EDI3 expression in ER-HER2+ breast cancer compared to the other molecular subtypes. Silencing EDI3 in ER-HER2+ cells significantly reduced cell survival in vitro and decreased tumor growth in vivo. However, a role for EDI3 in tumor metastasis in this breast cancer subtype was not explored. Therefore, in the present work we investigate whether silencing EDI3 in ER-HER2+ breast cancer cell lines alters phenotypes linked to metastasis in vitro, and metastasis formation in vivo using mouse models of experimental metastasis. METHODS To inducibly silence EDI3, luciferase-expressing HCC1954 cells were transduced with lentiviral particles containing shRNA oligos targeting EDI3 under the control of doxycycline. The effect on cell migration, adhesion, colony formation and anoikis was determined in vitro, and significant findings were confirmed in a second ER-HER2+ cell line, SUM190PT. Doxycycline-induced HCC1954-luc shEDI3 cells were injected into the tail vein or peritoneum of immunodeficient mice to generate lung and peritoneal metastases, respectively and monitored using non-invasive bioluminescence imaging. Metabolite levels in cells and tumor tissue were analyzed using targeted mass spectrometry and MALDI mass spectrometry imaging (MALDI-MSI), respectively. RESULTS Inducibly silencing EDI3 reduced cell adhesion and colony formation, as well as increased susceptibility to anoikis in HCC1954-luc cells, which was confirmed in SUM190PT cells. No influence on cell migration was observed. Reduced luminescence was seen in lungs and peritoneum of mice injected with cells expressing less EDI3 after tail vein and intraperitoneal injection, respectively, indicative of reduced metastasis. Importantly, mice injected with EDI3-silenced cells survived longer. Closer analysis of the peritoneal organs revealed that silencing EDI3 had no effect on metastatic organotropism but instead reduced metastatic burden. Finally, metabolic analyses revealed significant changes in choline and glycerophospholipid metabolites in cells and in pancreatic metastases in vivo. CONCLUSIONS Reduced metastasis upon silencing supports EDI3's potential as a treatment target in metastasizing ER-HER2+ breast cancer.
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Affiliation(s)
- Annika Glotzbach
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Katharina Rohlf
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Anastasia Gonscharow
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Simon Lüke
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Özlem Demirci
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
- Department of Biology, Science Faculty, Dicle University, Diyarbakir, Turkey
| | - Brigitte Begher-Tibbe
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Nina Overbeck
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Cristina Cadenas
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany
| | - Rosemarie Marchan
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139, Dortmund, Germany.
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Lawrenson R, Lao C, Stanley J, Teng A, Kuper‐Hommel M, Campbell I, Krebs J, Sika‐Paotonu D, Koea J, Meredith I, Gurney J. Does diabetes affect breast cancer survival? Cancer Rep (Hoboken) 2024; 7:e2040. [PMID: 38507264 PMCID: PMC10953831 DOI: 10.1002/cnr2.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective of this study is to investigate the influence of diabetes on breast cancer-specific survival among women with breast cancer in Aotearoa/New Zealand. METHODS This study included women diagnosed with invasive breast cancer between 2005 and 2020, with their information documented in the Te Rēhita Mate Ūtaetae-Breast Cancer Foundation National Register. Breast cancer survival curves for women with diabetes and those without diabetes were generated using the Kaplan-Meier method. The hazard ratio (HR) of breast cancer-specific mortality for women with diabetes compared to women without diabetes was estimated using the Cox proportional hazards model. RESULTS For women with diabetes, the 5-year and 10-year of cancer-specific survival were 87% (95% CI: 85%-88%) and 79% (95% CI: 76%-81%) compared to 89% (95% CI: 89%-90%) and 84% (95% CI: 83%-85%) for women without diabetes. The HR of cancer-specific mortality for patients with diabetes compared to those without diabetes was 0.99 (95% CI: 0.89-1.11) after adjustment for patient demographics, tumor characteristics, and treatments. Age at cancer diagnosis and cancer stage had the biggest impact on the survival difference between the two groups. When stratified by cancer stage, the cancer-specific mortality between the two groups was similar. CONCLUSIONS While differences in survival have been identified for women with diabetes when compared to women without diabetes, these are attributable to age and the finding that women with diabetes tend to present with more advanced disease at diagnosis. We did not find any difference in survival between the two groups due to differences in treatment.
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Affiliation(s)
- Ross Lawrenson
- Medical Research CentreThe University of WaikatoHamiltonNew Zealand
- CommissioningTe Whatu Ora WaikatoHamiltonNew Zealand
| | - Chunhuan Lao
- Medical Research CentreThe University of WaikatoHamiltonNew Zealand
| | - James Stanley
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | - Andrea Teng
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | | | - Ian Campbell
- Department of Surgery, Faculty of Health SciencesThe University of AucklandAucklandNew Zealand
| | - Jeremy Krebs
- Department of MedicineUniversity of OtagoWellingtonNew Zealand
| | - Dianne Sika‐Paotonu
- Dean's Department UOW & Division of Health SciencesUniversity of OtagoNew Zealand
| | - Jonathan Koea
- General SurgeryWaitakere HospitalAucklandNew Zealand
- Medical SurgeryThe University of AucklandAucklandNew Zealand
| | | | - Jason Gurney
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
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Chen SY, Duan XT, Li HF, Peng L, Wang ZQ, Xu GQ, Hua YJ, Zou X, You R, Ouyang YF, Liu YP, Gu CM, Yang Q, Jiang R, Zhang MX, Lin M, Xie YL, Lin C, Ding X, Xie RQ, Duan CY, Zhang WJ, Huang PY, Chen MY. Efficacy of sequential chemoradiotherapy combined with toripalimab in de novo metastatic nasopharyngeal carcinoma: A phase II trial. Cell Rep Med 2023; 4:101279. [PMID: 37951218 PMCID: PMC10694661 DOI: 10.1016/j.xcrm.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 11/13/2023]
Abstract
Locoregional radiotherapy added to chemotherapy has significantly improved survival in de novo metastatic nasopharyngeal carcinoma (mNPC). However, only 54% of de novo mNPC patients who received sequential chemoradiotherapy have complete or partial response 3 months after radiotherapy. This Simon's optimal two-stage design phase II study (NCT04398056) investigates whether PD-1 inhibitor could improve tumor control in combination with chemoradiation. The primary endpoint is objective response rate (ORR) at 3 months after radiotherapy. Twenty-two patients with primary mNPC are enrolled. The ORR at 3 months after radiotherapy is 81.8% (22.7% complete response, n = 5; 59.1% partial response, n = 13), and the disease control rate is 81.8%. The 3-year progression-free survival (PFS) rate is 44.9% (95% confidence interval 26.4%-76.3%). Fifteen patients (68.2%) experienced grade 3-4 adverse events. Patients with high baseline plasma Epstein-Barr virus DNA copy number (>104 cps/mL) show worse PFS. Addition of toripalimab to sequential chemoradiotherapy suggests promising tumor response in patients with primary mNPC.
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Affiliation(s)
- Si-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Xiao-Tong Duan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Hui-Feng Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Lan Peng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Zhi-Qiang Wang
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan, China
| | - Gui-Qiong Xu
- Department of Head and Neck Carcinoma and Radiotherapy, Zhongshan City People's Hospital, Zhongshan 528400, Guangdong, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; Nasopharyngeal Cancer Center, NanChang Hospital, Sun Yat-sen University (The First Hospital of Nanchang), Nanchang 330000, Jiangxi, China
| | - Chen-Mei Gu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Rou Jiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Meng-Xia Zhang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Mei Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Chao Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Ruo-Qi Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510000, Guangdong, China
| | - Wei-Jing Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong, China; Nasopharyngeal Cancer Center, NanChang Hospital, Sun Yat-sen University (The First Hospital of Nanchang), Nanchang 330000, Jiangxi, China.
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Zitricky F, Försti A, Hemminki A, Hemminki K. Conditional survival in breast cancer up to 10 years in the Nordic countries. Cancer Med 2023; 12:17945-17951. [PMID: 37578395 PMCID: PMC10524006 DOI: 10.1002/cam4.6436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Survival in breast cancer (BC) has developed favorably but late recurrences are still a problem. METHODS We model survival data from the NORDCAN database and analyze 1-, 5-, and 10-year relative survival and 5/1- and 10/5-year conditional survival in BC from Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) between 1971 and 2020. Conditional survival measures survival in those who had survived year 1 to reach year 5 (5/1), or in those who had survived year 5 to reach year 10 (10/5). RESULTS Almost all survival metrics were best for SE but survival in all countries improved in the course of time approaching the SE levels which were 98.3% for 1-year, 92.3% for 5-year, and 87.8% for 10-year survival. Conditional 10/5-year survival, covering 5 years, was better than 5/1-year survival, covering 4 years. A contributing factor is most likely the high rate of recurrence in period 2-5 years. The difference was observed for all countries but for DK 10/5-year survival approached 1-year survival and for NO and SE 10/5-year survival was only barely better than 5/1-year survival. The explanation to this was the excellent 10/5-year survival in DK compared to SE and particularly to NO. Literature search suggested that the reason for the relatively low 10/5-year survival in NO might be stagnant survival development in old patients. CONCLUSIONS We assume that late mortality is critically limiting survival in BC and either interference with the late metastatic process or effective treatment will be key to future improvements in BC survival.
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Affiliation(s)
- Frantisek Zitricky
- Biomedical Center, Faculty of MedicineCharles University PilsenPilsenCzech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ)HeidelbergGermany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ)German Cancer Consortium (DKTK)HeidelbergGermany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research ProgramUniversity of HelsinkiHelsinkiFinland
- Comprehensive Cancer CenterHelsinki University HospitalHelsinkiFinland
| | - Kari Hemminki
- Biomedical Center, Faculty of MedicineCharles University PilsenPilsenCzech Republic
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
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Lao C, Gurney J, Stanley J, Krebs J, Meredith I, Campbell I, Teng A, Sika-Paotonu D, Koea J, Lawrenson R. Association of diabetes and breast cancer characteristics at diagnosis. Cancer Causes Control 2023; 34:103-111. [PMID: 36409455 DOI: 10.1007/s10552-022-01654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aims to examine the association of diabetes and breast cancer characteristics at diagnosis in Aotearoa/New Zealand. METHODS Patients diagnosed with invasive breast cancer between 2005 and 2020 were identified from the National Breast Cancer Register. Logistic regression modeling was used to estimate the adjusted odds ratio (OR) of having stage III-IV cancer and the OR of having stage IV cancer for women with diabetes compared to those without diabetes. The adjusted OR of having screen-detected breast cancers for patients aged 45-69 years with diabetes compared to patients without diabetes was estimated. RESULTS 26,968 women were diagnosed with breast cancer, with 3,137 (11.6%) patients having diabetes at the time of cancer diagnosis. The probability of co-occurrence of diabetes and breast cancer increased with time. Māori, Pacific and Asian women were more likely to have diabetes than European/Others. The probability of having diabetes also increased with age. For patients with diabetes, the probability of being diagnosed with stage III-IV cancer and stage IV cancer was higher than for patients without diabetes (OR 1.14, 95% CI 1.03-1.27; and 1.17, 95% CI 1.00-1.38). Women aged 45-69 years with diabetes were more likely to have screen-detected cancer than those without diabetes (OR 1.13, 95% CI 1.02-1.26). CONCLUSIONS The co-occurrence of diabetes and breast cancer is becoming more common. Overall there is a small but significant adverse impact of having advanced disease for women with diabetes that is found at the time of breast cancer diagnosis, and this may contribute to other inequities that occur in the treatment pathway that may impact on patient outcomes.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Ian Campbell
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology & Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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7
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Torrisi R, Jacobs F, Miggiano C, De Sanctis R, Santoro A. HR +/HER2 - de novo metastatic breast cancer: a true peculiar entity? Drugs Context 2023; 12:dic-2022-12-2. [PMID: 36926051 PMCID: PMC10012832 DOI: 10.7573/dic.2022-12-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023] Open
Abstract
De novo metastatic breast cancer (dnMBC) accounts for ~6-10% of all breast cancers and for ~30% of MBC with increasing incidence over time. Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) tumours are the most frequent subtype with a similar incidence to that observed amongst recurrent MBC (rMBC). Higher frequency of PI3KCA and ARID2 mutations and a lower frequency of ESR1 mutations and of genes involved in DNA damage, as compared with rMBC, have been reported in HR+/HER2- dnMBC; however, these are not correlating with prognosis, whilst tumour mutational burden is inversely correlated with outcome. Bone represents the most frequent metastatic site, being the single site in up to 60% of patients with dnMBC. HR+/HER2- dnMBC has been generally reported to have better outcomes than rMBC, with a median overall survival ranging from 26 months to nearly 5 years in patients with favourable features such as age <40 years and bone-only disease, but not when compared with patients with late recurring disease (≥2-5 years). Analyses of the de novo cohorts within randomized clinical trials and large real-world series report a better outcome after treatment with CDK4/6 inhibitors and endocrine agents as compared to rMBC. Despite the limitations of retrospective studies and controversial results of the randomized trials, locoregional treatment of the primary tumour after response to systemic therapy appears to confer a survival benefit, particularly in patients with favourable prognostic factors. Altogether genomic, biological and clinical findings highlight HR+/HER2- dnMBC as a peculiar entity as compared with rMBC and deserve a dedicated treatment algorithm. This article is part of the Tackling clinical complexity in breast cancer Special Issue: https://www.drugsincontext.com/special_issues/tackling-clinical-complexity-in-breast-cancer/.
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Affiliation(s)
- Rosalba Torrisi
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy
| | - Flavia Jacobs
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Chiara Miggiano
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rita De Sanctis
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Department of Medical Oncology and Hematology, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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8
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Almasri H, Erjan A, Abudawaba H, Ashouri K, Mheid S, Alnsour A, Abdel-Razeq H. Clinical Characteristics and Survival Outcomes of Patients with De Novo Metastatic Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2022; 14:363-373. [PMID: 36340331 PMCID: PMC9628702 DOI: 10.2147/bctt.s383874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
Purpose Though less than 5% of patients with breast cancer present with De Novo Metastasis (dnMBC) in Western societies, this percentage may reach 30% in developing countries. In this study, we present survival outcomes of patients diagnosed with dnMBC treated at a tertiary center in a developing country. Patients and Methods Using hospital-based database, consecutive patients with dnMBC diagnosed between 2013 and 2017 were identified. Demographic data, tumor characteristics, types of treatment, and survival data were retrospectively collected. Results A total of 435 patients were included; median age (range) at time of diagnosis was 51 (24-85) years. Most of the tumors expressed hormone receptors (81% Estrogen Receptor positive, 77% Progesterone Receptor positive). Human epidermal growth factor receptor-2 (HER2) overexpression was reported in 134 (30.9%) patients, while only 24 (5.5%) had Triple Negative (TN) disease. Bone, lung and liver were the most common sites of metastasis involved in 70.6%, 36.1%, and 32.0%, respectively. The median Overall Survival (OS) for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, high tumor grade, advanced T-stage, TN-disease and metastasis to multiple sites, but not HER2 status, were associated with poor OS. On multivariate analysis, high tumor grade (Hazard Ratio =1.6, p=0.002), advanced T-stage (Hazard Ratio=1.6, p=0.003), and triple negative status (Hazard Ratio= 2.1, p=0.008) predicted poor OS. Conclusion The overall survival of patients with dnMBC remains poor. Better understanding of the disease behavior and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients' outcomes.
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Affiliation(s)
- Hanan Almasri
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ayah Erjan
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hebah Abudawaba
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Khaled Ashouri
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Sara Mheid
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anoud Alnsour
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan,Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan,Correspondence: Hikmat Abdel-Razeq, Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan, Tel +96265300460, Email
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9
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Lord SSJ, Daniels B, Kiely BE, O'Connell DL, Beith J, Pearson S, Chiew KL, Bulsara MK, Houssami N. Long term risk of distant metastasis in women with non-metastatic breast cancer and survival after metastasis detection: a population-based linked health records study. Med J Aust 2022; 217:402-409. [PMID: 35987521 PMCID: PMC9804703 DOI: 10.5694/mja2.51687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate the long term risk of distant metastases (DM) for women with initial diagnoses of non-metastatic breast cancer; to estimate breast cancer-specific and overall survival for women with DM. DESIGN Population-based health record linkage study. SETTING, PARTICIPANTS Women diagnosed with localised or regional primary breast cancer recorded in the NSW Cancer Registry, 2001-2002. MAJOR OUTCOME MEASURES Time from breast cancer diagnosis to first DM, time from first DM to death from breast cancer. SECONDARY OUTCOME time to death from any cause. RESULTS 6338 women were diagnosed with non-metastatic breast cancer (localised, 3885; regional, 2453; median age, 59 years [IQR, 49-69 years]). DM were recorded (to 30 September 2016) for 1432 women (23%; median age, 62 years [IQR, 51-73 years]). The 14-year cumulative DM incidence was 22.2% (95% CI, 21.1-23.2%; localised disease: 14.3% [95% CI, 13.2-15.4%]; regional disease: 34.7% [95% CI, 32.8-36.6%]). Annual hazard of DM was highest during the second year after breast cancer diagnosis (localised disease: 2.8%; 95% CI, 2.3-3.3%; regional disease: 9.1%; 95% CI, 7.8-10.3%); from year five it was about 1% for those with localised disease, from year seven about 2% for women with regional disease at diagnosis. Five years after diagnosis, the 5-year conditional probability of DM was 4.4% (95% CI, 3.7-5.1%) for women with localised and 10.4% (95% CI, 9.1-12.0%) for those with regional disease at diagnosis. Median breast cancer-specific survival from first DM record date was 28 months (95% CI, 25-31 months); the annual hazard of breast cancer death after the first DM record declined from 36% (95% CI, 33-40%) during the first year to 14% (95% CI, 11-18%) during the fourth year since detection. CONCLUSIONS DM risk declines with time from diagnosis of non-metastatic breast cancer, and the annual risk of dying from breast cancer declines with time from initial DM detection. These findings can be used to inform patients at follow-up about changes in risk over time since diagnosis and for planning health services.
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Affiliation(s)
- Sarah Sally J Lord
- The University of Notre Dame, Sydney, NSW.,NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW
| | - Benjamin Daniels
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, NSW
| | - Belinda E Kiely
- NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW
| | - Dianne L O'Connell
- The Daffodil Centre, the University of Sydney and Cancer Council NSW, Sydney, NSW.,The University of Newcastle, Newcastle, NSW
| | - Jane Beith
- Central Clinical School, Chris O'Brien Lifehouse, Sydney, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, NSW
| | | | - Max K Bulsara
- Institute of Health Research, University of Notre Dame, Fremantle, WA
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney and Cancer Council NSW, Sydney, NSW.,Sydney School of Public Health, the University of Sydney, Sydney, NSW
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10
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Xie Y, Gou Q, Zhang Y, Xie K, Zheng D, Luo C, Suo J, Zhong X, Luo T. Association between age at initial diagnosis and post-metastasis mortality among women with recurrent metastatic breast cancer in China. BMC Cancer 2022; 22:385. [PMID: 35397518 PMCID: PMC8994897 DOI: 10.1186/s12885-022-09454-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background Little is known about whether age at initial diagnosis influences the prognosis of recurrent metastatic breast cancer (rMBC). Here, we analyzed the association between age at initial diagnosis and rMBC mortality in China. Methods A total of 1636 women diagnosed with rMBC between 1989 and 2020 at West China Hospital, Sichuan University were included in this study. The age at initial diagnosis was categorized as young (≤ 40 years), middle-aged (41–64 years) and elderly (≥ 65 years). Post-metastasis mortality was the primary outcome and its associated factors were analyzed by Cox proportional hazards models. Results During a median follow-up of 5.2 years after initial diagnosis of breast cancer, 620 deaths were identified. Compared with middle-aged patients, elderly patients had a 70% increased risk of post-metastasis mortality (95%CI, 1.24–2.33) after adjusting for demographics, tumor characteristics and treatment modes. Similarly, elderly patients were associated with a 75% increased risk of post-metastasis mortality (95%CI, 1.19–2.59) compared with young patients. Subgroup analyses also showed similar trends. Conclusion Our findings suggest that in breast cancer, elderly patients at initial diagnosis face a higher risk of post-metastasis mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09454-y.
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11
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Xie Y, Ma J, Xia X, Zheng H, Gou Q. Prognosis and Treatment of Metastatic Breast Cancer From A Real-World Scenario in China: A Retrospective Cohort Study. Cancer Control 2022; 29:10732748221130568. [PMID: 36164749 PMCID: PMC9516424 DOI: 10.1177/10732748221130568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Although metastatic breast cancer (MBC) is considered incurable, a specific subset of patients exhibits prolonged survival and even achieve a "cure". We retrospectively identified predictive prognostic factors and systemic therapy models to find this group of potentially cured patients. METHODS Consecutive patients diagnosed with MBC from 1991-2016 in West China Hospital were included. Univariate and multivariate analyses were conducted to assess the association of clinical factors and systemic therapy models with overall survival (OS), breast cancer-specific survival (BCSS) and progression-free survival (PFS). RESULTS The median OS was 63.4 months. Age, tumor size, lymph node metastasis, histologic grade, molecular subtype, site and number of metastases and metastasis-free interval (MFI) were related to the prognosis of MBC (P < .05). Patients with T1, N0-1, luminal A, bone metastasis, OMBC (oligometastatic breast cancer) or metastasis-free interval (MFI) ≥ 3 years showed the median OS more than 10 years (P < .001). Independent prognostic factors that correlated with OS and BCSS were residence, lymph node metastasis, histologic grade, molecular subtype, and site of metastasis (P < .05). The group of sequential chemo-endocrine therapy (ST) in hormone receptor (HR)-positive MBC patients showed the highest overall response rate (ORR) (P < .05). However, patients who received endocrine therapy (ET) showed the best OS, BCSS and PFS in the first two-line treatment, followed by ST and chemotherapy (CT) (P < .05). CONCLUSIONS Our study shows the predictive prognostic factors and systemic therapy models to facilitate patients likely to achieve long-term survival.
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Affiliation(s)
- Yuxin Xie
- Department of Medical Oncology of Cancer Center, West China Hospital, 34753Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, 34753West China Hospital, Sichuan University, Chengdu, China
| | - Ji Ma
- Department of Medical Oncology, 34753West China Hospital, Sichuan University, Chengdu, China
| | - Xueming Xia
- Department of Medical Oncology of Cancer Center, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Hong Zheng
- Department of Medical Oncology of Cancer Center, West China Hospital, 34753Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, 34753West China Hospital, Sichuan University, Chengdu, China
| | - Qiheng Gou
- Department of Medical Oncology of Cancer Center, West China Hospital, 34753Sichuan University, Chengdu, China
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