Disease-free survival after resection of lung metastases in patients with breast cancer

doi:10.1016/S0748-7983(03)00074-X

European Journal of Surgical Oncology

Volume 29, Issue 6, August 2003, Pages 532-535

https://doi.org/10.1016/S0748-7983(03)00074-X Get rights and content

Abstract

Aims: Metastatic breast cancer is a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial.

Methods: Retrospective analysis of 25 patients with suspected pulmonary metastases operated between March 1989 and September 1998. Survival probabilities and disease-free survival was analysed using the Kaplan–Meier method and the log-rank test.

Results: The median survival rate after resection of lung metastases for the 21 patients was 96.9 months. The disease-free survival (DFS) after resection of lung metastases was 27.6 months. Survival was not influenced by the receptor status, lymph node involvement, number of lung metastases (p=0.8) or the disease-free interval (DFI) (0.59). DFS was, however, influenced by the DFI. With a DFI of <2 years survival was 8.5 months, whereas with a DFI >2 years it was 36.1 months (p=0.012). The DFS was influenced, but not statistically significant, by the number of lung metastases (n=1/n>1). The median DFS was 28.8 months with one metastasis and 13.1 months with multiple metastases (p=0.29).

Conclusions: The indication to remove solitary lung metastases in patients with previous breast cancer is supported by these findings. Especially when the disease-free interval is greater than two years.

Introduction

Resection of lung metastases in patients with previous breast cancer is a controversial issue.

The annual incidence of new cases of breast cancer in Germany is about 40 000. According to Ramming et al. 21%¹ of them will develop and die of lung metastases that were once potentially resectable. Primary breast cancer requires multimodal therapy. In the presence of lung metastases, breast cancer is considered a systemic disease. Resection of these lung metastases is not a standard form of treatment. It might be justified in a selected group of patients when local control of the primary tumor has been achieved and the number of pulmonary nodules is limited.² In recent studies, systemic treatment of advanced breast cancer offered a median survival of 21 months, after high-dosis chemotherapy 5-year survival was 10–20%.3., 4. Under what conditions does the resection of lung metastases offer similar or better results?

We have retrospectively analysed the long-term results of 25 patients operated on pulmonary nodules and breast cancer in their past medical history.

Section snippets

Material and methods

Twenty-five female patients were treated between March 1989 and September 1998. The data was retrospectively analysed from the patient records of the Department of Thoracic Surgery, University Hospital, Freiburg, Germany. This represents 0.49% (25/5048) of all the major lung resections for the same period of time. Preoperative bone scans as well as computed tomography of the lung and upper abdomen were routinely performed to confirm absence of disease at the primary site and elsewhere except

Results

Four patients were excluded from further analysis because of solitary benign lesions (n=2), primary bronchial carcinoma (n=1) and pleural carcinosis from breast cancer (n=1). Of the 21 patients, the median age was 54 years (range 35.3–77.3 years). The histology of the assumed pulmonary metastases was compared with the stains of the primary carcinoma. Follow-up is complete in all 21 patients who met the inclusion criteria.

Sternotomy was performed in six patients with bilateral lesions,

Discussion

Breast cancer is characterised by a tendency for metastatic spread to organs other than the lung, in particular to the skeleton. Despite this, in selected cases of isolated lung metastases, resection should be considered. In this small series of patients, former experiences were confirmed and the survival gain was comparable to that in patients with other primary tumors. In most series like this one, the complication rate is low and the operative mortality is zero.

In accordance to Friedel et al.

References (9)

K.P. Ramming
Surgery for pulmonary metastases
Surg Clin North Am
(1980)
J. Schirren et al.
Surgery of lung metastasis—indications, results and prognostic factors as an interdisciplinary concept
Pneumologie
(1994)
M. Pawlicki et al.
A phase II study of intravenous Navelbine and Doxorubicin combination in previously untreated advanced breast carcinoma
Oncologist
(2002)
W.P. Peters et al.
High-dose chemotherapy and peripheral blood progenitor cell transplantation in the treatment of breast cancer
Oncologist
(2000)

There are more references available in the full text version of this article.

Cited by (48)

Prognostic factors in patients with oligometastatic breast cancer – A systematic review
2020, Cancer Treatment Reviews
Oligometastatic breast cancer (OMBC) is a disease-entity with potential for long-term remission in selected patients. Those with truly limited metastatic load (rather than occult widespread metastatic disease) may benefit from multimodality treatment including local ablative therapy of distant metastases. In this systematic review, we studied factors associated with long-term survival in patients with OMBC.
Eligible studies included patients with OMBC who received a combination of local and systemic therapy as multimodal approach and reported overall survival (OS) or progression-free survival (PFS), or both. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of each included study. Independent prognostic factors for OS and/or PFS are summarized.
Of 1271 screened abstracts, 317 papers were full-text screened and twenty studies were included. Eleven of twenty studies were classified as acceptable quality. Definition of OMBC varied between studies and mostly incorporated the number and/or location of metastases. The 5-year OS ranged between 30 and 79% and 5-year PFS ranged between 25 and 57%. Twelve studies evaluated prognostic factors for OS and/or PFS in multivariable models. A solitary metastasis, >24 months interval between primary tumor and OMBC, no or limited involved axillary lymph nodes at primary diagnosis, and hormone-receptor positivity were associated with better outcome. HER2-positivity was associated with worse outcome, but only few patients received anti-HER2 therapy.
OMBC patients with a solitary distant metastasis and >24 months disease-free interval have the best OS and may be optimal candidates to consider a multidisciplinary approach.
Expert Consensus Document on Pulmonary Metastasectomy
2019, Annals of Thoracic Surgery
Citation Excerpt :
Breast cancer metastatic to lung is regarded as a systemic disease with no clear role for therapeutic PM. Despite this accepted practice pattern, several retrospective studies suggested a potential survival advantage in highly selected breast cancer patients undergoing PM for isolated or limited disease [6, 156–162]. A meta-analysis of 16 studies evaluating 1,937 patients undergoing breast cancer PM reported a 5-year survival of 46% [163].
Results of Pulmonary Resection: Other Epithelial Malignancies
2016, Thoracic Surgery Clinics
Citation Excerpt :
Patients without LNM had a 5-year survival rate of 38%. This finding is confirmed by some investigators28 but not by all.24,25 The use of prognostic group stratification may improve the ability to select patients for resection.
Supportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries: A breast health global initiative 2013 consensus statement
2013, Breast
Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life.
As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available.
The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care.
The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.
Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer
2013, Annals of Thoracic Surgery
Citation Excerpt :
Only Welter and colleagues [23] identified the receptor status to be of prognostic relevance. Ludwig and associates [30], Planchard and colleagues [10], and Kycler and coworkers [28] did not find a correlation between the HR status and survival. Nearly half of the patients with mBC demonstrate disparate receptor status of at least 1 receptor between primary and nodal disease [31, 32].
We investigated whether overall survival (OS) in patients with primary breast cancer (BC) is prolonged by pulmonary metastasectomy and which prognostic criteria may facilitate the decision in favor of thoracic surgical intervention.
We assessed the median OS of 81 women after resection of pulmonary primary BC metastases by means of Kaplan-Meier estimators. Statistical interferences regarding prognostic factors were based on univariate log-rank tests and multivariate Cox proportional hazards regression. Matched patients who had not undergone resection from the Munich Tumor Registry served as controls.
Between 1982 and 2007, 81 patients were recruited prospectively. In 81.5% of the patients R0 resection was achieved, which was associated with significantly longer median OS than occurred after R1 or R2 resection (103.4 months versus 23.6 months versus 20.2 months, respectively; p < 0.001). Multivariate analysis revealed R0 resection, number (n ≥ 2), size (≥ 3 cm), and estrogen receptor (ER) and/or progesterone receptor (PR) positivity of metastases as independent prognostic factors for long-term survival. Presence of metastases in mediastinal and hilar lymph nodes correlated with decreased survival only in the univariate analysis (32.1 versus 103.4 months; p = 0.095). Matched pair analysis confirmed that pulmonary metastasectomy significantly improved survival.
OS in patients with isolated pulmonary primary BC metastasis is prolonged by metastasectomy. Patients with multiple pulmonary lesions or metastases with negative hormone receptor (HR) status are at greater risk of disease relapse and should be followed closely. Moreover, additive treatment tailored to the biological subtype defined by HR expression should be considered for this group.
Significance of lymphovascular invasion in esophageal squamous cell carcinoma undergoing neoadjuvant chemotherapy followed by esophagectomy
2023, Esophagus

View all citing articles on Scopus

View full text

Disease-free survival after resection of lung metastases in patients with breast cancer

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Surg Clin North Am

Surgery of lung metastasis—indications, results and prognostic factors as an interdisciplinary concept

Pneumologie

A phase II study of intravenous Navelbine and Doxorubicin combination in previously untreated advanced breast carcinoma

Oncologist

High-dose chemotherapy and peripheral blood progenitor cell transplantation in the treatment of breast cancer

Oncologist