Peritoneal disease in breast cancer: A specific entity with an extremely poor prognosis

doi:10.1016/j.ejca.2009.04.027

European Journal of Cancer

Volume 45, Issue 12, August 2009, Pages 2146-2149

https://doi.org/10.1016/j.ejca.2009.04.027 Get rights and content

Abstract

Background

Peritoneal metastases are now a significant cause of morbidity and mortality in patients with advanced breast cancer. There are few published data regarding the prognosis, clinical characteristics and management of individuals with peritoneal metastases from breast cancer.

Methods

The electronic database at Imperial College Healthcare NHS Trust (Charing Cross Hospital) was searched for the terms ‘breast’, ‘cancer’ or ‘tumour’, ‘peritoneal’ and ‘ascites’ from 2000 to 2008. Those with confirmed peritoneal disease from breast cancer, as described on ultrasound or staging CT reports with a clinico-pathologic confirmed diagnosis, were included.

Results

A total of 1628 patients were screened and initially 168 patients were identified. A subsequent total of 44 individuals (2.7% of the cohort) were defined as having breast cancer with peritoneal secondaries and were included in the analysis. Of these, the majority (77%) had invasive ductal carcinomas (IDCs). While the median survival from the diagnosis of metastatic breast cancer measured 20.5 months (range 0.1–125 months), the median survival of patients with peritoneal disease was 1.56 months (range 0.2–27 months).

Conclusions

These data demonstrate that the median survival of patients with peritoneal breast cancer metastasis is surprisingly poor, with only a minority surviving more than 6 months. A specific association with invasive lobular carcinoma (ILC) was not observed. The dismal outcome of these individuals, despite further active therapy, merits their inclusion into clinical trials designed specifically for this group of patients.

Introduction

The pattern of metastases from breast cancer, the commonest malignancy in females, is changing, probably due to improved systemic and local therapies.1, 2, 3, 4 Although a specific association between invasive lobular carcinoma (ILC) and intra-peritoneal secondaries has been previously described,5, 6, 7, 8 breast cancer with peritoneal disease is rarely reported in the literature.

We have observed that peritoneal metastases are a significant cause of morbidity and mortality from both invasive ductal carcinoma (IDC) and ILC. Such patients with advanced disease often require frequent admission for drainage of recurrent ascites and we have estimated that around 10% of the in-patient admissions for patients with advanced breast cancer to our centre, are related to complications of peritoneal metastases.

Information on the management and prognosis of these individuals is scarce and under-represented in the literature. Herein, we describe our experience of the characteristics, management and prognosis of patients with peritoneal metastases from breast cancer from our cancer centre. The results suggest that this disease pattern represents a specific entity, with a very poor outcome.

Section snippets

Patients and methods

The electronic patient database at Charing Cross Hospital, Imperial College Healthcare NHS Trust was searched for the terms ‘breast, cancer or tumour, peritoneal and/or ascites’. Patients were treated at Imperial College Healthcare NHS Trust (Charing Cross Hospital site), London, United Kingdom, from January 2000 to November 2008. Individual patient data were obtained from the oncology database, patient records, and all imaging reports were reviewed according to a previously published protocol.⁹

Patient characteristics

A search of 1628 individuals with a corresponding number of individual patient scans initially yielded 168 patients, who were screened to confirm breast cancer as the underlying diagnosis and the presence of peritoneal disease, as described on their ultrasound or staging CT reports. A total of 14 patients were initially excluded as they were found not to have breast cancer as their primary cancer diagnosis, and 105 patients were subsequently excluded as they did not have breast cancer with

Discussion

We report, for the first time, that the prognosis of patients with breast cancer and peritoneal metastases, is dismal, even considering the fact that the majority of included individuals had advanced metastatic disease and were receiving second line therapy for their breast cancer. In addition, we fail to show any association between ILC and peritoneal disease as the majority of the patients in the cohort (34/44) had peritoneal disease metastasis arising after a diagnosis of IDC. Importantly,

Conflict of interest statement

None declared.

Acknowledgement

We are grateful to the patients who participated in this study.

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^f: M.T. and R.P. are equal contributors.

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Peritoneal disease in breast cancer: A specific entity with an extremely poor prognosis

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Patients and methods

Patient characteristics

Discussion

Conflict of interest statement

Acknowledgement

Clin Oncol (R Coll Radiol)

Gynecol Oncol

Ann Oncol

J Am Coll Surg

Breast cancer (metastatic)

Clin Evid

The efficacy of percutaneous vertebroplasty for vertebral metastases associated with solid malignancies

Eur J Cancer

The effects of trastuzumab on the CD4+CD25+FoxP3+ and CD4+IL17A+ T-cell axis in patients with breast cancer

Br J Cancer