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    Assessment of tumor characteristics and factors affecting survival in patients with primary metastatic breast carcinoma: a Multicenter Study of the Anatolian Society of Medical Oncology
    (Humana Press Inc, 2014) Uyeturk, Ummugul; Oksuzoglu, Berna; Akman, Tulay; Turker, Ibrahim; Sener, Nur; Tastekin, Didem; Bal, Oznur
    Primary metastatic breast cancer (PMBC) comprises 3-10 % of all BCs. PMBC is a heterogeneous disease. To date, little is known about the tumor characteristics, treatment results, and overall survival ( OS) of patients with PMBC. Patients were considered to have PMBC if distant metastasis was evident within 3 months of the initial diagnosis of BC. Between September 2007 and April 2013, 466 PMBC patients were included in this study and analyzed retrospectively. The median age of the patients was 50 (18- 90) years. Bone/ soft tissue metastases were more frequent in the hormone receptor (HR)(+) human epidermal growth factor receptor ( HER) 2(-) group compared with the HR(-) HER2(-) and HR(-) HER2(-) groups ( p < 0.001), whereas visceral organ metastasis was more frequent in the HR(-) HER2(-) and HR(-) HER2(-) groups ( p < 0.001). The OS was affected by Eastern Cooperative Oncology Group performance status, tumor histology, receptor status, and the site of metastasis ( p < 0.001, p < 0.001, p < 0.001, and p = 0.011, respectively). According to the first-line systemic treatment choices of the patients, the longest median OS was observed in the HR(?) HER2(-) group who received hormonotherapy combined with trastuzumab after chemotherapy ( 86 months, 95 % CI 23.8-148.1) and the shortest median OS was observed in the HR(-) HER2(-) group who received chemotherapy only ( 24 months, 95 % CI 17.9-30.0) ( p < 0.001). Bisphosphonate therapy or radiotherapy had no significant effect on OS ( p = 0.733, 0.603). In multivariate analysis, hormonotherapy, chemotherapy + trastuzumab, trastuzumab + hormonotherapy following chemotherapy, and surgery were the most important prognostic factors for OS, respectively ( p < 0.001, p = 0.025, p = 0.027, p = 0.029). The general characteristics of the primary tumor are important for the prognosis and survival of patients with PMBC. Interestingly, patients who underwent primary breast tumor surgery, even those at the metastatic stage upon admission, had the longest survival.
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    Prognostic Factors for Recurrence-Free Survival in Patients with HER2-Positive Early-Stage Breast Cancer Treated with Adjuvant Trastuzumab
    (Karger, 2013) Tonyali, Onder; Coskun, Ugur; Sener, Nur; Inanc, Mevlude; Akman, Tulay; Ulas, Arife; Yazilitas, Dogan
    Background: The objective of this study was to identify prognostic factors affecting the recurrence-free survival (RFS) in patients who received a 52-week trastuzumab therapy for HER2-positive early stage breast cancer (EBC). Patients and Methods: The medical records of all patients with EBC from 10 centers were analyzed. Pathologic and clinical tumor characteristics were evaluated in 424 female patients who received 52 weeks of adjuvant trastuzumab for HER2-positive EBC. Survival was estimated using the Kaplan-Meier method. Univariate analyses of RFS were performed with the log-rank test. Independent prognostic and predictive factors affecting RFS were assessed by Cox regression analysis. Results: Median follow-up time was 33.1 months (range 9.2-75.9 months). 3-year RFS and overall survival were 87 and 97%, respectively. In multivariate analysis, patients aged 70 years or over (p = 0.017, relative risk (RR) 2.7, 95% confidence interval (CI) 1.19-6.13), patients with > 9 positive lymph nodes (p = 0.001, RR 2.52, 95% CI 1.42-4.46), and those with progesterone receptor-negative tumors (p = 0.006, RR 2.33, 95% CI 1.27-4.27) had worse RFS. Conclusion: In spite of a 52-week adjuvant trastuzumab treatment, classic poor prognostic factors for invasive EBC remained as such in patients with HER2-positive EBC.