Elsevier

Gynecologic Oncology

Volume 99, Issue 1, October 2005, Pages 65-70
Gynecologic Oncology

Abdominal carcinomatosis in women with a history of breast cancer

https://doi.org/10.1016/j.ygyno.2005.05.013Get rights and content

Abstract

Objectives.

The goals of this study were to: (1) characterize the etiology of abdominal carcinomatosis, (2) identify clinical features predictive of primary ovarian/peritoneal cancer, and (3) evaluate the survival impact of cytoreductive surgery among patients with advanced ovarian/peritoneal cancer and a history of breast cancer.

Methods.

Patients with a history of prior breast cancer undergoing surgical exploration for abdominal carcinomatosis between 1/1/88 and 12/31/02 were retrospectively identified from tumor registry databases. Logistic regression analysis was used to explore clinical characteristics predictive of primary ovarian/peritoneal cancer versus recurrent breast cancer. Survival analyses and comparisons were performed using the Kaplan–Meier and Cox proportional hazard models.

Results.

Seventy-nine patients underwent surgery for abdominal carcinomatosis a median of 5.39 years after initial breast cancer diagnosis. Abdominal carcinomatosis was due to primary ovarian/primary peritoneal cancer in 74.7% of cases. A history of Stage I breast cancer [OR = 10.73, 95%CI = 2.6–43.7, P < 0.001] and the lack of a prior breast cancer recurrence [OR = 10.60, 95%CI = 2.5–45.2, P < 0.001] were independently predictive of primary ovarian/peritoneal cancer. Among patients with primary ovarian/peritoneal cancer, optimal (≤1 cm) cytoreductive surgery was associated with a median survival of 44.0 months compared to 18.0 months for patients with suboptimal residual disease [HR = 6.81, 95%CI = 3.37–13.77, P < 0.0001]. Recurrent breast cancer was associated with a median survival time of 6.4 months.

Conclusions.

Among patients with prior breast cancer presenting with abdominal carcinomatosis, early-stage disease and the absence of a prior recurrence were predictive of primary ovarian/peritoneal cancer. Optimal cytoreductive surgery was associated with a significant survival advantage for patients with primary ovarian/peritoneal cancer.

Introduction

Breast cancer is the most common malignancy among women in the United States. The current 5-year relative survival rates of 97% and 78% for localized and regional disease, respectively, indicate that a significant proportion of breast cancer patients will experience prolonged survival [1]. Although the risk of breast cancer recurrence diminishes over time, late recurrences well into the second decade of surveillance can occur. Among patients with metastatic breast cancer, extra-hepatic and extra-skeletal abdominal locales account for 10% of cases. Ascites and carcinomatosis may be present in as many as 5.4% and 2.6% of cases, respectively [2].

The female genital system is a common site of second primary non-mammary malignancies. Specifically, a personal history of breast cancer is associated with a two to four-fold increase in the risk of ovarian cancer [3]. In breast cancer patients, the clinical distinction between recurrent metastatic breast cancer and a new, second primary malignancy of the ovary or peritoneum can be difficult. The clinical relevance of this distinction is predicated on the disparate management strategies for ovarian/peritoneal cancer (cytoreductive surgery followed by platinum-based combination chemotherapy) compared to metastatic breast cancer (hormonal therapy versus chemotherapy). Consequently, the goals of this study were to: (1) characterize the etiology of abdominal carcinomatosis in women with a history of breast cancer, (2) identify clinical features predictive of primary ovarian/peritoneal cancer, and (3) evaluate the survival impact of cytoreductive surgery among patients with advanced ovarian/peritoneal cancer subsequent to a diagnosis of breast cancer.

Section snippets

Methods

Approval to conduct this study was obtained from the Johns Hopkins Medical Institutions (JHMI) Clinical Research Committee and Joint Committee on Clinical Investigation. All patients with a personal history of primary breast cancer who subsequently underwent clinical management for a diagnosis of abdominal carcinomatosis at the JHMI between 1/1/88 and 12/31/02 were identified through the JHMI Tumor Registry, the Kelly Gynecologic Oncology Service clinical database, and the Department of

Patient characteristics

A total of 1501 patients with a history of recurrent breast cancer (n = 1274) or breast cancer with another primary site of malignancy (n = 227) were identified through the JHMI databases during the study interval. Of these, 79 patients were documented as presenting with abdominal carcinomatosis ≥30 days subsequent to the diagnosis of primary breast cancer. The demographic characteristics of patients with breast cancer diagnosis are shown in Table 1.

The median patient age at breast cancer

Predictors of primary ovarian/peritoneal cancer

Multivariate logistic regression analysis of demographic and clinical variables revealed that only AJCC Stage I breast cancer (odds ratio [OR] = 10.73, 95% confidence interval [95%CI] = 2.6–43.7, P = 0.001) and the absence of a prior breast cancer recurrence (OR = 10.60, 95%CI = 2.5–45.2, P = 0.001) were independently and statistically significantly associated with a diagnosis of primary ovarian/peritoneal cancer versus recurrent breast cancer (Table 2).

Although not statistically significant,

Surgical outcome and survival analysis

All patients underwent a minimum of exploratory laparotomy or diagnostic laparoscopy with tissue biopsy, which was the only procedure performed in 9 cases. Additional procedures were performed with the following frequencies: unilateral or bilateral salpingo-oophorectomy (n = 68), omentectomy or omental biopsy (n = 59), total or supracervical hysterectomy (n = 54), tumor cytoreduction (n = 43), retroperitoneal lymph node sampling (n = 39), small bowel resection (n = 11), large bowl resection (n

Discussion

Breast cancer and ovarian cancer rank as the second and fifth leading causes of cancer-related death, respectively, among United States women [1]. One in eight women will have breast cancer during their lifetimes and one in 70 will be diagnosed with ovarian cancer [3]. Currently, about half of all patients with a diagnosis of breast cancer will experience a recurrence and one third will die of their disease [11].

Several factors may predispose a patient to develop both breast cancer and ovarian

References (19)

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