University of South Carolina, Columbia, SC
Anuhya Kommalapati , Sri Harsha Tella , Apar Kishor Ganti , Pavankumar Tandra
Background: Recent randomized trials evaluating the role of surgery in de novo stage 4 BC yielded mixed results indicating that patient/tumor characteristics might influence the survival. We analyzed the predictors of survival after LRT in stage 4 BC by using National Cancer Data Base (NCDB). Methods: Retrospective analysis of histologically confirmed infiltrative ductal (IDC), lobular (LC) and metaplastic stage 4 BC patients from 2004-2015 using NCDB. The study cohort was divided into 2 subsets based on the therapy received: no LRT and LRT (surgery ± radiation). The LRT subset was randomized into training and validation cohorts. In the training cohort, Cox proportional method was used to calculate HRs based on which a 17 point survival prediction scoring system was developed (Table). Both the cohorts were stratified into 3 groups based on the scores- group (G)1 (0-3), G2 (4-7) and G3 (8-17). Kaplan Meier (KM) method and log-rank test were used to compare survival among the 3 groups. We validated the prognostic score by comparing the OS between the respective groups in each cohort. Results: A total of 67,978 patients met the inclusion criteria (median age 61 y). The patients in LRT subset (21,120) had significantly better survival (median: 45 vs 24 m) (p < .0001). The 3 groups in training cohort showed significant difference in the OS (p < 0.0001) – G1 having better prognosis. The 3-year OS rates of the groups were 84% (G1), 66% (G2), and 38% (G3). On validation, comparable OS was seen between the respective groups in each cohort (p = 0.77). Conclusions: LRT was associated with improved OS in de novo stage 4 BC. Based on the patient/tumor characteristics, we developed a prediction model to characterize the prognostication in patients undergoing LRT for stage 4 BC.
Parameter | HR (CI does not include 1);p < 0.05 | Score |
---|---|---|
Age | - | - |
≤49 | - | 0 |
50-74 | 1.17 | 1 |
≥75 | 2.19 | 2 |
Race | - | - |
White | - | 0 |
Black | 1.18 | 1 |
CDCC | - | - |
0-1 | - | 0 |
2-3 | 1.72 | 1 |
Grade | - | - |
1-2 | - | 0 |
3-4 | 1.45 | 1 |
Histology | - | - |
IDC | - | 0 |
LC | 1.21 | 1 |
Metaplastic | 2.06 | 2 |
Receptor status | - | - |
TP | - | 0 |
HR+/HER- | 1.60 | 1 |
HR-/HER+ | 1.46 | 1 |
TN | 4.54 | 3 |
Metastasis | - | - |
Bone | 1.36 | 1 |
Brain | 2.48 | 2 |
Liver | 1.44 | 1 |
Lung | 1.31 | 1 |
All | 4.36 | 3 |
Combos | 2.65 | 2 |
T4 | 1.25 | 1 |
No Radiation | 1.40 | 1 |
Surgical margins positive | 1.39 | 1 |
Lymphovascular invasion | 1.23 | 1 |
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