Prognostic factors determining survival in breast cancer patients presenting with metastatic disease

Although patients with advanced breast cancer usually die of their disease, the clinical course is highly variable. Numerous investigators have examined potential prognostic factors predicting time to recurrence for primary (localized) breast cancer. Less attention has been paid to evaluating prognostic factors in patients presenting with metastatic disease. A group of 86 women with metastatic breast cancer diagnosed between 1974 and 1984 was studied to determine the effect of certain prognostic factors on survival. Univariate analysis of these factors indicates that specific sites of recurrence, estrogen receptor (ER) status, size of the primary tumor at original diagnosis, and tumor histology; i.e., tumor differentiation, were significantly associated with predicting survival in patients presenting with metastatic disease. Poor survival, i.e., less than, or equal to, 22 months from initial presentation, is associated with a primary tumor greater than five cm., ER level less than 10 fmol/mg. of protein, lung and bone marrow recurrence, and poorly differentiated histology. Menstrual status, age, bone or lymph node site of metastases, and elapsed time between patient knowledge of symptoms and subsequent initial medical evaluation were not significant predictors of survival in patients presenting with metastatic disease.