Reply to Is initially metastatic breast carcinoma different from recurrent metastatic breast carcinoma?
Authors: E. Chamorey, J. Barrière, J.M. Ferrero, R. Largillier
Journal: Annals of Oncology (2008)

We are grateful for the comments provided by Altundag et al. and would like to answer the important points that were raised. As stated in our article [1.Largillier R. Ferrero J.M. Doyen J. et al.Prognostic factors in 1038 women with metastatic breast cancer.Ann Oncol. 2008; 19: 2012-2019Abstract Full Text Full Text PDF PubMed Scopus (266) Google Scholar], metastasis-free interval (MFI) appeared to be related to survival after recurrence in the univariate analysis which is consistent with previously published studies [2.Vogel C.L. Azevedo S. Hilsenbeck S. et al.Survival after first recurrence of breast cancer. The Miami experience.Cancer. 1992; 70: 129-135Crossref PubMed Scopus (76) Google Scholar, 3.Insa A. Lluch A. Prosper F. et al.Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients.Breast Cancer Res Treat. 1999; 56: 67-78Crossref PubMed Scopus (148) Google Scholar, 4.Chang J. Clark G.M. Allred D.C. et al.Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor.Cancer. 2003; 97: 545-553Crossref PubMed Scopus (225) Google Scholar]. But contrary to our study, adjuvant chemotherapy, size of primary tumor or age were not univariate significant prognostic factors in these previous articles and were not included in their multivariate analysis. Our multivariate analysis has included these parameters which may have influenced the independent prognostic impact of MFI in the final model. Moreover, our study has included 1038 patients. The smaller number of patients could have been a limiting factor for Chang et al. with 346 patients, Vogel et al. with 433 patients and Insa et al. with 439 patients. Besides, these previous studies have not included the period from 1995 to 2005 in which new treatments appeared such as taxanes or trastuzumab. Finally, we agree with Altundag et al. that patients with initially metastatic breast carcinoma have an equivalent outcome in term of overall survival compared with recurrent metastatic breast carcinoma [5.Jimeno A. Amador M.L. González-Cortijo L. et al.Initially metastatic breast carcinoma has a distinct disease pattern but an equivalent outcome compared with recurrent metastatic breast carcinoma.Cancer. 2004; 100: 1833-1842Crossref PubMed Scopus (17) Google Scholar, 6.Saydam B.K. Goksel G. Korkmaz E. et al.Comparison of the clinical and pathological features between patients with recurrent metastatic breast carcinoma and patients with initially metastatic breast carcinoma.Saudi Med J. 2008; 29: 81-86PubMed Google Scholar]. Taking into account those patients may have changed our results. Nevertheless, as specified in the ‘Patients and methods’ part, we restricted our study to breast cancer patients with no evidence of distant metastases at the time of inclusion. In summary, our results support that MFI may be deemed as a prognostic factor reflecting the multiparametric variability of the disease and could be relevant for predicting survival from time of metastatic occurrence. It should be kept in mind that retrospective and nonrandomized studies should be considered as exploratory studies. In addition, prognostic factors vary considerably between different studies and are sometimes contradictory with respect to the selection of patients, availability of biological and clinical parameters, patients’ follow-up and methods of analysis.