Bartmann Catharina, Wischnewsky Manfred, Stüber Tanja, Stein Roland, Krockenberger Mathias, Häusler Sebastian, Janni Wolfgang, Kreienberg Rolf, Blettner Maria, Schwentner Lukas, Wöckel Achim, Diessner Joachim
Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
Faculty of Mathematics and Computer Science, University of Bremen, Universitätsallee GW1, 28359, Bremen, Germany.
Arch Gynecol Obstet. 2017 Jan;295(1):211-223. doi: 10.1007/s00404-016-4225-4. Epub 2016 Nov 10.
The development of metastases is the most aggressive attribute of breast cancer. In this retrospective multicenter study, we evaluated if and how the different pathological breast cancer subtypes influence the spreading of tumor cells, the development of metastasis and the survival of breast cancer patients.
This retrospective German multicenter study is based on the BRENDA collective including 9625 breast cancer patients treated in the adjuvant setting. We used the χ tests for the analysis of the categorical variables between groups of patients with different sites of metastasis. Survival distributions and median survival times were estimated using the Kaplan-Meier product-limit method. The log-rank test was applied to compare survival rates. The Cox proportional hazards model was used to estimate the hazard ratio and confidence intervals.
886 women developed metastases during a time interval of 53 months after primary diagnosis. Luminal A tumor patients were more likely to get bone metastases than lung, liver or CNS metastases. Patients with a triple-negative subtype were, however, the least affected by metastasis in the skeleton. They were most likely to develop visceral metastases. Location, numbers of metastases herein and the subtype influenced the overall survival (OAS). Altogether, the best OAS was found in patients with the luminal A subtype, the worst in patients with the triple-negative subtype.
Knowledge of the typical metastatic pattern of the subtypes of breast cancer will help to personalize therapeutic options and follow-up examinations of cancer patients.
转移的发生是乳腺癌最具侵袭性的特征。在这项回顾性多中心研究中，我们评估了不同病理类型的乳腺癌亚型是否以及如何影响肿瘤细胞的扩散、转移的发生以及乳腺癌患者的生存情况。
这项回顾性德国多中心研究基于BRENDA队列，该队列包括9625例接受辅助治疗的乳腺癌患者。我们使用χ检验分析不同转移部位患者组之间的分类变量。采用Kaplan-Meier乘积限界法估计生存分布和中位生存时间。应用对数秩检验比较生存率。使用Cox比例风险模型估计风险比和置信区间。
886名女性在初次诊断后的53个月时间间隔内发生了转移。管腔A型肿瘤患者发生骨转移的可能性高于肺、肝或中枢神经系统转移。然而，三阴性亚型患者受骨骼转移的影响最小。他们最有可能发生内脏转移。转移的部位、转移灶数量及亚型影响总生存期（OAS）。总体而言，管腔A型亚型患者的OAS最佳，三阴性亚型患者最差。
了解乳腺癌亚型的典型转移模式将有助于个性化癌症患者的治疗方案选择和随访检查。
