Ren Zhiyong, Li Yufeng, Hameed Omar, Siegal Gene P, Wei Shi
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Pathol Res Pract. 2014 May;210(5):301-6. doi: 10.1016/j.prp.2014.01.008. Epub 2014 Feb 12.
Approximately 90% of breast cancer mortality is due to metastases that are resistant to adjuvant therapies. Thus, assessment of factors associated with clinical outcomes in patients with advanced breast cancer is of significant importance. Despite the recent improvement in early detection, between 5 and 10% of breast cancer patients are diagnosed with metastasis at initial presentation or, rarely, before the primary breast cancer has been identified. These patients typically have poorer survival outcomes compared to those who develop distant metastasis subsequently. Yet, the prognostic relevance in these patients has not been intensively explored. In this study, we analyzed breast cancer patients with distant metastasis at the time of diagnosis between 1997 and 2010 (n=194) to identify the clinicopathological factors significant for overall survival. By univariate analysis, race, estrogen receptor (ER) and progesterone receptor status were significantly associated with overall survival, while race and ER remained independent factors in multivariate analysis. Being Caucasian and overexpressing of ER both showed a significantly decreased hazard of death (P=0.015 and 0.017, respectively). Reflecting these findings, the overall survival differed significantly between breast subtypes, with the luminal subtype and triple negative disease being associated with the longest and worst survival, respectively. Further, multi-organ involvement was associated with a worse prognosis than those with single organ metastasis, whereas no significant difference in survival was found between the different anatomic sites (bone, viscera and brain). Our findings suggest that it is predominantly the intrinsic nature of the tumor along with the genetic makeup of the patient that predicts the prognostic outcome in those patients with advanced disease at presentation.
大约90%的乳腺癌死亡是由对辅助治疗耐药的转移灶所致。因此，评估晚期乳腺癌患者临床结局的相关因素具有重要意义。尽管早期检测最近有所改善，但仍有5%至10%的乳腺癌患者在初次就诊时被诊断为转移，极少数情况下，在原发性乳腺癌被发现之前就已发生转移。与随后发生远处转移的患者相比，这些患者的生存结局通常较差。然而，这些患者的预后相关性尚未得到深入研究。在本研究中，我们分析了1997年至2010年间诊断时发生远处转移的乳腺癌患者（n = 194），以确定对总生存有显著意义的临床病理因素。单因素分析显示，种族、雌激素受体（ER）和孕激素受体状态与总生存显著相关，而在多因素分析中，种族和ER仍然是独立因素。白种人和ER过表达均显示死亡风险显著降低（分别为P = 0.015和0.017）。反映这些发现的是，不同乳腺亚型的总生存存在显著差异，管腔型亚型和三阴性疾病分别与最长和最差的生存相关。此外，多器官受累的预后比单器官转移者更差，而不同解剖部位（骨、内脏和脑）之间的生存无显著差异。我们的研究结果表明，在就诊时患有晚期疾病的患者中，主要是肿瘤的内在性质以及患者的基因构成预测了预后结局。
