Management and prognosis of solitary pulmonary metastasis in breast cancer patients: A report of 21 cases

Objective: To assess the clinical characteristics, treatment and prognostic factors of solitary pulmonary metastasis (SPM) in breast cancer patients. Methods: From January 1999 to January 2009, 35 cases of patients with solitary pulmonary nodule (SPN) were treated at our center. All of the patients had a history of breast cancer and underwent surgery for an SPN. Results: The median time from mastectomy to SPN was 48 months (range, 6-177 months). The histology of SPN revealed pulmonary metastasis of breast cancer in 21 (60%) patients, primary lung cancer in 8 (22.9%) patients, and benign condition in 6 (17.1%) patients. In the 21 with solitary pulmonary metastasis (SPM) of breast cancer, the 2, 3 and 5-year survival rates after pulmonary mastectomy were 95.2%, 71.4% and 19.0%, respectively. The median progress free survival (PFS) from the pulmonary mastectomy to progress was 32 months, and the median survival time after surgery of SPM was 43 months (range, 12-103 months). Chemotherapy after pulmonary mastectomy was the strongest predictor of outcome by univariate analysis. Other factors included the initial size of breast tumor, the lymph-vascular invasion and time to SPN >60 months. Conclusion: Patients with SPN are a heterogeneous group. For patients with lung metastasis of breast cancer, the surgical approach should be the diagnosis and treatment of choice. For patients with pulmonary metastasis of breast cancer, the systemic treatment after pulmonary mastectomy may give an optimistic prognosis.