Predictors of skeletal complications in patients with metastatic breast carcinoma

BACKGROUND. The high rate of incidence of skeletal complications in women w ith metastatic breast carcinoma appears to contribute significantly to thei r morbidity. Although recent trials have demonstrated the efficacy of bisph osphonates in preventing skeletal complications in selected patients, to th e authors' knowledge the incidence rate of skeletal complications in an uns elected population of women with metastatic breast carcinoma is unknown. Th e current study was designed to examine the incidence rate of skeletal comp lications in a large unselected group of women with metastatic breast carci noma to determine predictors of these complications. METHODS. All women (n = 718) diagnosed with metastatic breast carcinoma bet ween 1981-1991 at the study institution were studied retrospectively. RESULTS. Greater than 50% of the women developed skeletal complications; am ong these women, 51% had > 1 complication. Approximately 80% of those with bone-limited disease at the time of diagnosis developed complications, as d id 60% of those with bone and visceral disease and 21% of those with no bon e disease. By univariate analysis, the site of initial metastatic disease, abnormal alkaline phosphatase, and a disease free interval of < 3 years wer e predictive of skeletal complications. Multivariate analysis revealed that bone involvement at the time of diagnosis was predictive of subsequent ske letal complications. CONCLUSIONS. In this large retrospective study with extensive follow-up, sk eletal complications were extremely common and repetitive, although complic ations predated patient death by greater than or equal to 1 year in the gro up of women presenting with any bone disease. The presence of bone disease at the time of initial presentation was predictive of skeletal complication s. In this group of patients, the authors were unable to identify a subgrou p with a low rate of skeletal complications. (C) 2000 American Cancer Socie ty.