title: Prediction of outcome of patients with metastatic breast cancer: evaluation with prognostic factors and Nottingham prognostic index.
abstract: OBJECTIVE
  The purpose of this study is to analyze the survival rate of patients with metastatic breast cancer and to evaluate the outcome of these patients using prognostic factors and Nottingham prognostic index.
  
  
  METHODS
  From February 1992 to August 2008, 135 patients with metastatic breast cancer were treated at the Changhua Christian Hospital. In these patients, we evaluated the significance of the following factors in predicting the survival rate after the occurrence of metastasis: age, initial stage at primary diagnosis, histological grade, Karnofsky performance status (KPS), estrogen receptor (ER), progesterone receptor status, human epidermoid growth factor receptor 2 overexpression status, number of axillary lymph node metastasis, history of adjuvant radiotherapy and/or chemotherapy, disease-free interval, status of local recurrence, status of various sites of distant metastases, number of distant metastases, and Nottingham prognostic index.
  
  
  RESULTS
  The 1-, 2-, and 5-year survival rates were 53.3%, 25.2%, and 1.5%, respectively. In the univariate analysis, KPS, histological grade, ER status, initial stage at primary diagnosis, number of axillary lymph node metastasis, liver metastasis, disease-free interval, first-/second-/third-line chemotherapy for recurrence or metastasis, number of metastases, and Nottingham prognostic index had significant impact on survival. The median survival of patients determined as corresponding to Nottingham low-risk group, intermediate-risk group, and high-risk group was 29.3, 17.9, and 4.6 months, respectively. In our multivariate analysis, Karnofsky performance status (p = 0.030) and Nottingham prognostic index (p ≤ 0.0001) were significant prognostic factors for survival, while first-/second-/third-line chemotherapy for recurrence or metastasis (p = 0.002) was a significant predictor for the outcome of the treatment.
  
  
  CONCLUSIONS
  The prognosis of patients with metastatic breast cancer is poor. In spite of the fact that many advances in treatment have been made, numerous additional questions have arisen; new drugs and therapeutic regimens are needed to improve the outcomes of patients, and further well-designed randomized trials are warranted.
authors.affiliation: Department of Radiation Oncology, Changhua Christian Hospital, 135, Nan Shiau Street, Changhua, Taiwan, 500, Republic of China. giessen@kimo.com
authors.forename: Mu-Tai
authors.initials: MT
authors.lastname: Liu
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Huang
authors.forename: Ai-Yih
authors.initials: AY
authors.lastname: Wang
authors.forename: Chia-Chun
authors.initials: CC
authors.lastname: Huang
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Tung-Hao
authors.initials: TH
authors.lastname: Chang
authors.forename: Chu-Pin
authors.initials: CP
authors.lastname: Pi
authors.forename: Hao-Han
authors.initials: HH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D013624:Taiwan; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor