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. 2024 Jun;205(2):333-347.
doi: 10.1007/s10549-024-07265-2. Epub 2024 Mar 5.

Survival among patients with untreated metastatic breast cancer: "What if I do nothing?"

Jennifer K Plichta  1   2   3 , Samantha M Thomas  4   5 , Xuanji Wang  6 , Susan G R McDuff  4   7 , Gretchen Kimmick  4   8 , E Shelley Hwang  9   4
Affiliations

Survival among patients with untreated metastatic breast cancer: "What if I do nothing?"

Jennifer K Plichta et al. Breast Cancer Res Treat. 2024 Jun.

Abstract

Purpose: We sought to assess survival outcomes of patients with de novo metastatic breast cancer (dnMBC) who did not receive treatment irrespective of the reason.

Methods: Adults with dnMBC were selected from the NCDB (2010-2016) and stratified based on receipt of treatment (treated = received at least one treatment and untreated = received no treatments). Overall survival (OS) was estimated using the Kaplan-Meier method, and groups were compared. Cox proportional hazards models were used to identify factors associated with OS.

Results: Of the 53,240 patients with dnMBC, 92.1% received at least one treatment (treated), and 7.9% had no documented treatments, irrespective of the reason (untreated). Untreated patients were more likely to be older (median 68 y vs 61 y, p < 0.001), have higher comorbidity scores (p < 0.001), have triple-negative disease (17.8% vs 12.6%), and a higher disease burden (≥ 2 metastatic sites: 38.2% untreated vs 29.2% treated, p < 0.001). The median unadjusted OS in the untreated subgroup was 2.5 mo versus 36.4 mo in the treated subgroup (p < 0.001). After adjustment, variables associated with a worse OS in the untreated cohort included older age, higher comorbidity scores, higher tumor grade, and triple-negative (vs HR + /HER2-) subtype (all p < 0.05), while the number of metastatic sites was not associated with survival.

Conclusions: Patients with dnMBC who do not receive treatment are more likely to be older, present with comorbid conditions, and have clinically aggressive disease. Similar to those who do receive treatment, survival in an untreated population is associated with select patient and disease characteristics. However, the prognosis for untreated dnMBC is dismal.

Keywords: Breast cancer; Metastatic; Outcomes; Stage IV; Survival.

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Conflict of interest statement

  1. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

  2. Dr. J. Plichta is a recipient of research funding by the Color Foundation and Earlier.org (PI: Plichta), unrelated to the submitted work. JP serves on the Editorial Committee for the American Joint Committee on Cancer (AJCC), Breast Cancer panel for the AJCC, and the National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnosis panel. JP is on the editorial board for the journal (Breast Cancer Research and Treatment), but she was not involved in the editorial process for this manuscript.

  3. Dr. E.S. Hwang serves on the NCCN Breast Cancer Risk Reduction panel.

  4. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Figures

Figure 1.
Figure 1.
Patient flow diagram of inclusion and exclusion criteria. NCDB: National Cancer Database. WHO: World Health Organization. *N=319 Patients underwent treatment, but had unavailable systemic treatment data.
Figure 2.
Figure 2.
Unadjusted overall survival for patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by treatment group: (A) treated vs untreated, (B) treated with systemic therapy vs treated with non-systemic therapy vs untreated.
Figure 2.
Figure 2.
Unadjusted overall survival for patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by treatment group: (A) treated vs untreated, (B) treated with systemic therapy vs treated with non-systemic therapy vs untreated.
Figure 3.
Figure 3.
Unadjusted median overall survival for patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by treatment (untreated vs. treated w/ non-systemic therapy vs. treat w/ systemic therapy) and by survival time (if patients survived X months, where X = 1 month, 2 months, 3 months, 6 months, or 12 months).
Figure 4.
Figure 4.
Unadjusted overall survival for untreated patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by: (A) tumor subtype (HR+/HER2− vs HER2+ vs TNBC), (B) number of metastatic sites (=number of organ systems involved), (C) location of metastatic site/involvement, (D) stage (IVA vs IVB vs IVC). HR+: hormone receptor positive. HER2: human-epidermal-growth-factor-receptor-2. TNBC: triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, HER2-negative).
Figure 4.
Figure 4.
Unadjusted overall survival for untreated patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by: (A) tumor subtype (HR+/HER2− vs HER2+ vs TNBC), (B) number of metastatic sites (=number of organ systems involved), (C) location of metastatic site/involvement, (D) stage (IVA vs IVB vs IVC). HR+: hormone receptor positive. HER2: human-epidermal-growth-factor-receptor-2. TNBC: triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, HER2-negative).
Figure 4.
Figure 4.
Unadjusted overall survival for untreated patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by: (A) tumor subtype (HR+/HER2− vs HER2+ vs TNBC), (B) number of metastatic sites (=number of organ systems involved), (C) location of metastatic site/involvement, (D) stage (IVA vs IVB vs IVC). HR+: hormone receptor positive. HER2: human-epidermal-growth-factor-receptor-2. TNBC: triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, HER2-negative).
Figure 4.
Figure 4.
Unadjusted overall survival for untreated patients with de novo metastatic breast cancer from the National Cancer Database, diagnosed 2010–2016, stratified by: (A) tumor subtype (HR+/HER2− vs HER2+ vs TNBC), (B) number of metastatic sites (=number of organ systems involved), (C) location of metastatic site/involvement, (D) stage (IVA vs IVB vs IVC). HR+: hormone receptor positive. HER2: human-epidermal-growth-factor-receptor-2. TNBC: triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, HER2-negative).
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