Das primär ossär metastasierte Mammakarzinom

Abstract

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 cancer (disease-free interval less than 3 months or distant metastases at 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 metastases (disease-free interval of more than 3 months) served as controls. Results: The first metastatic site was the skeleton in 55 patients, visceral organs in 32 women, while 25 patients had concomitant osseous and visceral metastases. 58% of patients (n=32) with primary metastases confined to the skeleton had large tumours (T3-4) and 87% of these women were node-positive. Bone metastases were predominantly found in the axial skeleton (thoracic spine 69%, pelvis 55%, lumbar spine 51%). The symptoms and complications associated with bone metastases were: pain (67%), fractures (40%), hypercalcaemia (24%), myelopathy (13%) and spinal cord compression (7%). The median overall survival (OAS) in all 112 patients with primary metastatic breast cancer was 18 months. Kaplan-Meier analysis revealed that patients with bone metastases had a significantly 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 patients with distant metastases were node-negative, which shows that the axillary lymph node status is not an ideal prognostic factor for assessing haematogenic metastases. Patients with primary metastatic breast cancer confined to the skeleton have a better prognosis than patients with visceral metastases. The metastatic affinity of highly differentiated tumours to the skeleton possibly contributes to the better prognosis of patients with skeletal metastases.