Metastatic (stage IV) breast cancer: presence of distant metastasis (M1 per TNM 8th editi...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-BREAST-STAGE-IV-METASTATIC`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-08 \| очікує клінічного підпису
Хвороби	`DIS-BREAST`
Джерела	`SRC-ESMO-BREAST-METASTATIC-2024` `SRC-NCCN-BREAST-2025`

Походження тривожної ознаки

Визначення	Metastatic (stage IV) breast cancer: presence of distant metastasis (M1 per TNM 8th edition) involving any organ system (bone, liver, lung, brain, peritoneum, other). Stage IV breast cancer is currently incurable with available systemic therapy; treatment intent is disease control, quality of life, and life prolongation. Stage IV status is the gating criterion for palliative systemic therapy (CDK4/6i+AI for HR+/HER2-; THP for HER2+; pembro+chemo or PARPi for TNBC) rather than curative-intent neoadjuvant/adjuvant approaches. Fires to route ALGO-BREAST-1L step 4 (TNBC branch) from early-stage neoadjuvant (IND-BREAST-TNBC-EARLY-NEOADJUVANT) toward metastatic evaluation (step 6: BRCA mutation gate → PARPi vs pembro+chemo).
Клінічний напрям	intensify
Категорія	other
Змінює алгоритм	ALGO-BREAST-1L

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "stage_group",
      "value": "IV"
    },
    {
      "finding": "stage_group",
      "value": "IVA"
    },
    {
      "finding": "stage_group",
      "value": "IVB"
    },
    {
      "finding": "stage_group",
      "value": "metastatic"
    },
    {
      "finding": "disease_extent",
      "value": "metastatic"
    },
    {
      "finding": "distant_metastasis",
      "value": true
    },
    {
      "finding": "m_stage",
      "value": "M1"
    }
  ],
  "type": "stage_classification"
}

Нотатки

W5c RF authoring. Converts free-text `{condition: "Stage IV (locally recurrent unresectable or distant metastatic)"}` in ALGO-BREAST-1L step 4 (TNBC metastatic gate) into a formal RF entity. The trigger fires on any M1 / Stage IV finding. ALGO-BREAST-1L step 4 routes: if_true (RF fires = metastatic): next_step: 6 (BRCA mutation gate) if_false (RF doesn't fire = early stage): IND-BREAST-TNBC-EARLY-NEOADJUVANT Locally recurrent unresectable disease is treated with metastatic-intent therapy and is included in the stage IV / distant metastasis definition for this routing purpose. Note: Recheck `disease_extent` finding key naming convention against KB engine vocabulary when available. ESMO-BREAST-METASTATIC-2024 source (`SRC-ESMO-BREAST-METASTATIC-2024`) may need ID verification. CHARTER §6.1: Two-reviewer clinical co-lead signoff required before removing draft: true.

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Algorithms

ALGO-BREAST-1L - ALGO-BREAST-1L