Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2018 Aug;7(8):4156-4169. doi: 10.1002/cam4.1668. Epub 2018 Jul 9.
INTRODUCTION: Population-based data on the incidence and prognosis of bone metastases at diagnosis of breast cancer are currently limited. Hence, we conducted this study to analyze the incidence proportions and prognostic factors of patients with breast cancer and bone metastases at the time of cancer diagnosis. MATERIALS AND METHODS: Patients with primary invasive breast cancer and bone metastases at initial diagnosis between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results (SEER) dataset and Fudan University Shanghai Cancer Center (FUSCC) cohort. Multivariable logistic regression was performed to identify predictors of the presence of bone metastases at diagnosis. Univariate and multivariate analyses were performed to determine the effects of each variable on survival. RESULTS: Of 229, 195 patients from SEER database included in the analysis, 8295 patients had bone metastases at initial diagnosis, reflecting 3.6% of the entire study population, and 65.1% of the subset with metastatic disease to any distant site. Patients with hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative represented the highest incidence proportions among patients with metastatic disease (73.9%). Among entire cohort, multivariable logistic regression identified eight factors as predictors of the presence of bone metastases at diagnosis. Median OS for the patients with bone metastases in SEER and FUSCC cohorts was 30.0 and 68.2 months, respectively. Patients with HR-positive HER2-positive subtype had the longest median OS, and patients with triple-negative subtype showed the shortest median OS. Multivariable Cox model in SEER cohort confirmed age, histology, grade, tumor subtype, extraosseous metastatic sites, history of primary surgery, insurance status, marital status, and income as independent prognostic factors for both OS and BCSS. CONCLUSIONS: The findings of this study provide population-based estimates of the incidence and prognosis for patients with bone metastases at initial diagnosis of breast cancer.
简介：目前，基于人群的乳腺癌诊断时骨转移发生率和预后的数据有限。因此，我们进行了这项研究，以分析诊断时患有乳腺癌和骨转移的患者的比例和预后因素。 材料和方法：使用监测、流行病学和最终结果（SEER）数据集和复旦大学上海癌症中心（FUSCC）队列，确定了 2010 年至 2014 年间初诊时患有原发性浸润性乳腺癌和骨转移的患者。采用多变量逻辑回归分析来确定诊断时存在骨转移的预测因素。采用单变量和多变量分析来确定每个变量对生存的影响。 结果：在纳入分析的 229195 例 SEER 数据库患者中，有 8295 例患者在初诊时发生骨转移，占整个研究人群的 3.6%，占远处任何部位转移患者的 65.1%。激素受体（HR）阳性人表皮生长因子受体 2（HER2）阴性的转移性疾病患者发生率最高（73.9%）。在整个队列中，多变量逻辑回归确定了 8 个因素作为诊断时发生骨转移的预测因素。在 SEER 和 FUSCC 队列中，有骨转移的患者的中位 OS 分别为 30.0 和 68.2 个月。HR 阳性 HER2 阳性亚型的患者中位 OS 最长，三阴性亚型的患者中位 OS 最短。SEER 队列中的多变量 Cox 模型证实，年龄、组织学、分级、肿瘤亚型、骨外转移部位、初次手术史、保险状况、婚姻状况和收入是 OS 和 BCSS 的独立预后因素。 结论：本研究结果提供了诊断时乳腺癌骨转移患者的发生率和预后的人群估计。
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