title: Clinical relevance and low tumor-initiating properties of oligometastatic breast cancer in pulmonary metastasectomy.
abstract: Metastatic breast cancer is a systemic disease. However, certain subsets of patients, such as those with oligometastatic breast cancer (OMBC), have long-term survival prospects. Our aim was to evaluate the clinical relevance of OMBC in pulmonary metastasectomy of recurrent breast cancer. We also investigated lung metastases for the prevalence of CD44+/CD24-/low tumor cells and evaluated their prognostic significance. We reviewed data from a registry of breast cancer patients with lung metastases who underwent pulmonary metastasectomy at Jikei University Hospital. We analyzed prognostic factors for overall survival (OS) and progression-free survival (PFS) after metastasectomy and examined the prognostic difference between OMBC and non-OMBC patients. CD44+/CD24-/low tumor cells were detected by immunohistochemical analysis of lung metastases sites. Among 17 breast cancer patients with lung metastasis, 5-year OS and PFS rates were 72 and 36 %, respectively. Better OS was observed among patients with OMBC. Patients with OMBC, estrogen receptor-positive cells, and disease-free intervals of >8 years had better PFS. The presence of CD44+/CD24-/low tumor cells influenced progression after lung metastasectomy, with median PFS of only 6 months in patients with a high prevalence of cancer-initiating cells. CD44+/CD24-/low cells with cancer-initiating properties were present in only 9 % ± 3 of patients with OMBC, but were found in 73 % ± 12 of patients with non-OMBC. Pulmonary metastasectomy may be a treatment option for OMBC patients with lung metastases. Better prognosis of OMBC may be associated with low levels of cancer-initiating cells.
authors.affiliation: Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan, m-rei@jikei.ac.jp.
authors.forename: Rei
authors.initials: R
authors.lastname: Mimoto
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Imawari
authors.forename: Makiko
authors.initials: M
authors.lastname: Kamio
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kato
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nogi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Toriumi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirooka
authors.forename: Ken
authors.initials: K
authors.lastname: Uchida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D051927:CD24 Antigen / Q000378:metabolism; D002471:Cell Transformation, Neoplastic / Q000378:metabolism / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism; D008175:Lung Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D059146:Metastasectomy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate
chemical_list: D051927:CD24 Antigen; C497483:CD44 protein, human; D018960:Hyaluronan Receptors