BREAST-CANCER WITH SKELETAL METASTASES AT INITIAL DIAGNOSIS - ANALYSIS TO PROGNOSIS, COURSE, AND THERAPY

The purpose of the present study was to analyse prognostic variables, predict the site of metastatic recurrence and to compare the clinical course and survival of patients with primary metastases. Material and methods: The records of 112 patients with primary metastatic breast ca ncer (disease-free interval less than 3 months or distant metastases a t the time of diagnosis) treated at the Department of Gynaecology and Obstetrics of the University of Heidelberg between 1970 and 1990 were reviewed retrospectively. 648 patients with secondary distant metastas es (disease-free interval of more than 3 months) served as controls. R esults: The first metastatic site was the skeleton in 55 patients, vis ceral organs in 32 women, while 25 patients had concomitant osseous an d visceral metastases. 58% of patients (n=32) with primary metastases confined to the skeleton had large tumours (T3-4) and 87% of these wom en were node-positive. Bone metastases were predominantly found in the axial skeleton (thoracic spine 69%, pelvis 55%, lumbar spine 51%). Th e symptoms and complications associated with bone metastases were: pai n (67%), fractures (40%), hypercalcaemia (24%), myelopathy (13%) and s pinal cord compression (7%). The median overall survival (GAS) in all 112 patients with primary metastatic breast cancer was 18 months. Kapl an-Meier analysis revealed that patients with bone metastases had a si gnificantly longer overall survival (median 31 months) than those with visceral metastases (median 10 months). Conclusion: The existence of distant metastases at the time of diagnosis is usually associated with aggressive malignancy or an advanced primary tumour. 11.4% of patient s with distant metastases were node-negative, which shows that the axi llary lymph node status is not an ideal prognostic factor for assessin g haematogenic metastases. Patients with primary metastatic breast can cer confined to the skeleton have a better prognosis than patients wit h visceral metastases. The metastatic affinity of highly differentiate d tumours to the skeleton possibly contributes to the better prognosis of patients with skeletal metastases.