4.6 Review

Breast cancer: emerging principles of metastasis, adjuvant and neoadjuvant treatment from cancer registry data

Journal

JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
Volume 149, Issue 2, Pages 721-735

Publisher

SPRINGER
DOI: 10.1007/s00432-022-04369-4

Keywords

Breast cancer; Tumor growth; Local recurrence; Positive lymph node; Metastasis; Adjuvant treatment; Survival

Categories

Ask authors/readers for more resources

Through analysis of patient data, key time periods and factors for primary breast cancer and metastasis were identified. The study results suggest that the growth period of breast cancer is 12.5 years, metastasis occurs approximately 8.8 years after diagnosis, local recurrences happen around 5 years, and regional lymph node metastasis occurs after 3.5 years. Based on these findings, principles for the metastasis process and adjuvant treatments were proposed, including 50% eradication of primary breast cancer and selective and partial eradication of bone and lung metastases.
Purpose Growing primary breast cancers (PT) can initiate local recurrences (LR), regional lymph nodes (pLN) and distant metastases (MET). Components of these progressions are initiation, frequency, growth duration, and survival. These characteristics describe principles which proposed molecular concepts and hypotheses must align with. Methods In a population-based retrospective modeling approach using data from the Munich Cancer Registry key steps and factors associated with metastasis were identified and quantified. Analysis of 66.800 patient datasets over four time periods since 1978, reliable evidence is obtained even in small subgroups. Together with results of clinical trials on prevention and adjuvant treatment (AT) principles for the MET process and AT are derived. Results The median growth periods for PT/MET/LR/pLN comes to 12.5/8.8/5/3.5 years, respectively. Even if 30% of METs only appear after 10 years, a pre-diagnosis MET initiation principle not a delayed one should be true. The growth times of PTs and METs vary by a factor of 10 or more but their ratio is robust at about 1.4. Principles of AT are 50% PT eradication, the selective and partial eradication of bone and lung METs. This cannot be improved by extending the duration of the previously known ATs. Conclusion A paradigm of ten principles for the MET process and ATs is derived from real world data and clinical trials indicates that there is no rationale for the long-term application of endocrine ATs, risk of PTs by hormone replacement therapies, or cascading initiation of METs. The principles show limits and opportunities for innovation also through alternative interpretations of well-known studies. The outlined MET process should be generalizable to all solid tumors.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available