Impact of oligometastatic disease on survival in ER positive breast cancer: A population-based analysis.
Notice bibliographique
Résumé
e19109 Background: Estrogen positive (ER) advanced breast cancers (ABC) are associated with a longer survival compared to other subtypes. However, clinical equipoise remains for the management of oligometastatic disease. While recent phase I and II data support the use of metastasis-directed therapy, breast cancer patients remain underrepresented and real-world outcomes for breast cancer patients with directed treatment for oligometastases is lacking. Methods: The BC Cancer Breast Cancer Outcomes Unit (BCOU) database was utilized to identify patients with ER positive breast cancer referred to BC Cancer from 2005-2014 with documented metastases. Baseline clinical, pathological and treatment data were compiled. Overall survival (OS) was compared between the group with oligometastatic disease(OM) (defined as < = 5 foci of metastases) and the group with non-oligometastatic disease (defined as > = 6 foci of metastases) using Kaplan-Meier survival curves. Key secondary endpoints included metastasis-directed treatment impact, based on the site of metastasis, local control (LC) and distant failure (DF) rate. Results: A total of 938 patients met the inclusion criteria. Of these, 191 (20.4%) had OM and 747 (79.6%) had widespread disease at 1st diagnosis of ABC. The groups were well balanced for clinical characteristics (all p > 0.05), with a median age of 59yrs (23-99). 84% were ductal carcinomas, 14% were also HER2 positive. Sites of oligometastases were bone (66.5%), liver (12.0%), brain (8.4%) and lung (5.8%). Median follow-up was 7.4 yrs. Median OS was 24 mo (95% CI 20.2, 27.8) for patients with OM and 11 mo (9.5, 12.5) for those with widespread disease (p < 0.0001). In the OM group, 114 (59.7%) of patients received metastasis-directed treatment, whereas 77 (40.3%) did not. Treatment modalities included radiation in 53.4% of patients, surgery in 8.9% of patients and stereotactic body radiotherapy (SBRT) in 3.7%. Median OS was 24 mo (18.3, 29.7) for patients who received metastasis-directed treatment and 23 mo (17.5, 28.5) for those who did not (p = 0.954). Patients with bone-only metastases had a median OS of 27mo with directed treatment and 25mo without directed-treatment (p = 0.334). Conclusions: Oligometastatic state was associated with a significantly better OS. Metastasis-directed treatment was associated with a non-significant OS difference in patients with bone-only metastases in a real world cohort. However, the impact of modern systemic treatment and SBRT methods are evolving. Large prospective randomized studies of this approach merit further study.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».