JAMA Sub-Journal: These advanced breast cancers are expected to be cured! Chinese scholars propose to modify the stage of the disease

▎The content team editor of WuXi AppTec.
Among newly diagnosed breast cancer patients, about 3%-8% have developed distant metastases and are stage IV patients.

Although the overall survival rate of stage IV breast cancer is poor, with the progress of systemic treatment, the prognosis of some stage IV breast cancers with limited metastasis sites (such as those with bone or distant lymph node metastasis) is gradually improving.

Recently, JAMA Network Open, a sub-issue of the Journal of the American Medical Association, published a case analysis study that showed that stage IV breast cancer with distant lymph node metastasis can be regarded as a local disease and is expected to be cured through active treatment.

This prompted us to re-examine the staging and prognosis of patients with distant lymph node metastases.

The corresponding authors of the study are Professor Wang Shui and Dr.
Zhou Wenbin from Jiangsu Provincial People's Hospital (The First Affiliated Hospital of Nanjing Medical University).

Screenshot source: JAMA Network Open This research data comes from the US SEER (Surveillance, Epidemiology and Final Outcomes) database and included 2033 patients diagnosed with breast cancer from 2010 to 2014.
These patients are on average 62 years old, about 3/ 4 is white.

The research team focused on the analysis of ipsilateral supraclavicular lymph node metastasis (ISLM, no distant metastasis, currently classified as stage III disease), distant lymph node metastasis (DLNM) breast cancer patients and other distant metastases of stage IV breast cancer Survival rate of patients.

The data showed: 212 cases (10.
4%) were ISLM patients, the 3-year breast cancer specific survival rate was 63.
24%, and the 3-year overall survival rate was 53.
46%; 346 cases (17.
0%) were DLNM patients, 3-year breast cancer-specific The survival rate was 64.
54%, and the 3-year overall survival rate was 62.
67%; 1475 cases (72.
6%) were non-DLNM stage IV patients, and the 3-year breast cancer-specific survival rate was 41.
20%; the 3-year overall survival rate was 38.
21%. ▲ Breast cancer-specific survival (A) and overall survival (B) of patients with distant lymph node metastasis (DLNM), ipsilateral supraclavicular lymph node metastasis (ISLM) and other distant metastases (DM) (picture source: reference [1]) Compared with ISLM patients, there was no statistical difference in the 3-year breast cancer-specific survival rate and 3-year overall survival rate of DLNM patients.

In contrast, the 3-year breast cancer-specific mortality and the 3-year total mortality of other stage IV patients who are not DLNM have nearly doubled.

In these DLNM patients, first surgery and radiotherapy were significantly associated with improvement in overall survival.

Compared with patients who did not undergo surgery, surgery significantly reduced the breast cancer-specific mortality risk and total mortality risk by 83% and 79%; similarly, radiotherapy significantly reduced the total mortality risk by 54%.

The research team stated, “As far as we know, this cohort study is the first to provide direct evidence from a large number of samples, showing that DLNM breast cancer is expected to be cured, similar to N3c (stage IIIC) breast cancer, and the prognosis is significantly better than other types of stage IV.
Disease.

This shows that DLNM may not be metastatic breast cancer, so it is necessary to reassess the impact of breast cancer lymph node metastasis.

"Image source: 123RF In fact, ISLM was also classified as stage IV disease before 2002 and needs to be accepted separately.
Radiotherapy or surgery combined with radiotherapy.

However, with the advancement of chemotherapy and endocrine therapy, the survival rate of ISLM patients gradually catches up with stage IIIB breast cancer patients, and is much higher than that of stage IV patients, which promotes the change of ISLM staging.

In a review article published in the same period, the Sun Yat-sen University Cancer Center team agreed that lymph node status is "one of the most important factors" in breast cancer staging, and it is reasonable to reassess DLNM breast cancer patients.
"This study also provides Important evidence shows that local treatment for ISLM (stage IIIC) is also effective
for DLNM .
For DLNM patients, more local treatments should be considered, which may further improve the overall survival and prognosis of these patients. "Related reading JCO: Lower dose, halved side effects, just as effective! Classic breast cancer preventive drugs are expected to benefit more women Utidal has been approved for listing in China: New opportunities for advanced breast cancer treatment, recommended by CSCO guidelines! "Liu Leaf Blade-Oncology": led by Professor Xu Binghe, the Chinese innovative drug pyrrotinib for the second-line treatment of HER2-positive breast cancer has been supported again! Sun Yat-sen University Cancer Center's research wins JAMA, triple-negative breast cancer maintenance treatment improves 5-year disease-free survival The survival rate of breast cancer is "the most toxic"! The precision adjuvant therapy "Fudan Plan" is listed in the reference materials of Journal of the American Medical Association-Oncology[1] Pan H, et al.
, (2021).
patients with breast cancer with distant vs ipsilateral supraclavicular lymph node metastases.
JAMA Netw Open, DOI: 10.
1001/jamanetworkopen.
2021.
1809.
[2] Zou Y, et al.
, (2021).
Distant lymph node metastases from breast cancer - Is it time to review TNM cancer staging?.
JAMA Netw Open, DOI: 10.
1001/jamanetworkopen.
2021.
2026.
[3] Time to Revisit Distant Nodal Status in Breast Cancer Curability?.
Retrieved March 17, 2021, from https:// com/hematologyoncology/breastcancer/91650 Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.

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