Survival Outcomes in Breast Cancer Patients With Metastatic Bone Disease

To evaluate the survival outcomes of breast cancer patients with metastatic bone disease and to assess whether these patients exhibit different prognoses compared to those with more extensive metastatic involvement.

Systemic therapy including endocrine therapy, chemotherapy and targeted agents remains the cornerstone of treatment for patients with stage IV breast cancer, particularly those with bone metastases. Palliative radiotherapy also plays a key role in bone metastases, especially for symptom control and managing skeletal and complications. Although these modalities have significantly improved outcomes, the prognostic variation among patients with bone-only disease-ranging from solitary to widespread metastases-warrants further investigation. This study aims to evaluate survival outcomes among breast cancer patients with varying patterns of bone metastases.

This retrospective cohort study analyzed data from 4000 breast cancer patients treated between 2006 and 2024. Patients were evaluated for bone metastases, which were confirmed through imaging reviewed via the Picture Archiving and Communication System (PACS). Patients with confirmed bone metastases were categorized into solitary, oligometastatic (2-5 sites), or multiple metastases groups. Data on demographics, tumor characteristics, treatment regimens, surgery types, and survival outcomes were collected. Survival analyses were conducted using Kaplan-Meier curves and compared using log-rank tests.

One hundred and eighty-seven patients with metastatic bone disease were identified. 21 patients had solitary bone metastases only with a mean survival of 14.6 years. Additionally, 30 patients had oligometastatic bone disease only with a mean survival of 7 years. Another 31 patients had multiple bone only metastases, with also a mean survival of 7 years. Finally, 105 of the 187 patients had other metastases alongside bone metastases in other organs including the lung, liver, and brain with a mean survival of 6.3 years.

These findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard these findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard, these findings highlight the need for further research into whether selected patients may benefit from integrating local treatment approaches, including surgery, into their management.