Abstract P2-18-04: Differential prognosis of pulmonary lumpectomy in patients with a history of curative breast cancer

Abstract

Abstract Objective: Treatment of patients with a history of breast cancer who are diagnosed as newly found solid pulmonary nodule is still controversial. Our study is to find out whether the pulmonary nodule represents a primary cancer, metastasis, or benign lesion secondary to breast cancer can be differentially prognostic. Methods: A total of 165 consecutive patients who underwent surgery or biopsy for pulmonary nodules between 2007 and 2013 after curative operation for breast cancer were reviewed. The postoperative survival rate was analyzed and the difference in survival rate was assessed between groups of pulmonary nodules representing a primary cancer, metastasis, and benign lesion. Results: Among these 165 patients, median age was 59 and mean follow-up was 51 months (range from 5 to 398). The pathologic diagnoses of pulmonary nodules were pulmonary metastases of breast cancer in 71 patients (43%), primary lung cancer in 59 (35.8%), and other diagnoses in 35 (21.2%) (hyperplasia in 11; pneumonia in 9; granuloma in 6; sclerosing hemangioma and pulmonary fibrosis in 4 each). In those who were diagnosed as malignant pulmonary tumor, about one half (56.4%) were secondary malignant and the rest were metastatic. There was no statistically difference in median age or disease free interval between operation date of breast surgery and pulmonary surgery or biopsy among these groups. However, those who were diagnosed as primary malignant or benign lesion had significantly higher incidence of isolated pulmonary nodule shown on their CT scan results (P=0.036). The incidence of positive lymph node involvement and negative ER/PR status was significantly higher in metastatic breast cancer patients (63.8% and 70.6%, respectively). Among patients with metastatic pulmonary nodules, rates of discordance between primary breast tumor and metastasis foci were 20.3%, 23.7% and 14.7% for ER, PR and HER2, respectively, which changed a lot the regimen used for treatment of metastatic breast cancer. Both the 5-year and 10-year disease-free survival from the initial mastectomy were significantly shorter in metastatic breast cancer patients (72.9%, 35.3%) when compared with patients with primary pulmonary cancer (82.9%, 53.8%) or pulmonary benign lesions (91.6%, 67.8%). Prognostic factors in metastatic breast cancer patients were a disease-free interval of >60 months with 10-year survival of 48.3% (P<0.05), solitary lung metastasis is associated with a survival rate of 78.9% after 5 years and of 48.7% after 5 and 10 years, and this is statistically significant compared to multiple metastases. Conclusions: We think that pulmonary lumpectomy is the best option in selected cases of solitary or multiple pulmonary nodules from breast cancer, which can be useful for differential diagnosis, predicting prognosis and deciding the drug treatment strategy in some cases. Citation Format: Zhebin Liu, Yihua Sun, Fangjing Ma, Hong Ling, Keda Yu, Guangyu Liu, Genhong Di, Zhen Hu, Canmin Chen, Yifeng Hou, Jiong Wu, Zhenzhou Shen, Zhimin Shao. Differential prognosis of pulmonary lumpectomy in patients with a history of curative breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-18-04.