Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium.
Breast Cancer Res Treat. 2020 May;181(1):115-125. doi: 10.1007/s10549-020-05597-3. Epub 2020 Mar 19.
To explore the impact of breast cancer subtype on metastatic behavior and long-term outcome defined as breast cancer specific survival (BCSS).
Retrospective single centre cross-sectional study of 5972 patients with newly diagnosed, unilateral first diagnosis of breast cancer, diagnosed 2000-2010. Patients had either early breast cancer (EBC) treated primarily by surgery (SURG n = 5072), neoadjuvant systemic therapy (NEO n = 592), or upfront metastatic disease (META n = 308). Surrogate breast cancer subtypes were defined according to classical pathological criteria. Analysis was performed using Kaplan-Meier method and logistic/Cox regression.
After median follow-up time of 103.6 months (IQR 73.4-139.2 months), 817 patients with EBC at diagnosis (14.4%) developed distant metastases of which 621 (12.2%) SURG and 196 (33.1%) NEO. Metastasis rate after EBC was: LuminalA 8.1%, LuminalB1(HER2-) 20.4%, LuminalB2(HER2+) without (neo)adjuvant trastuzumab 21.7%, LuminalB2(HER2+) with trastuzumab 9.0%, HER2Positive(ER-) without trastuzumab 30.0%, HER2Positive(ER-) with trastuzumab 19.9% and TripleNegative 25.3%. There were major differences in site of first metastases according to subtype. For single site first metastases, median BCSS assessed from time of metastases was worst for brain localization (13.9 months) and best for bone (48.4 months). Multiple sites of first metastases had worse BCSS from date of metastases than single site first metastases (median BCSS for 1 site 40.0, 2 sites 27.1, ≥ 3 sites 20.5 months). Median BCSS from date of metastases is longer in upfront metastases compared to secondary metastases after EBC (43.4 vs. 27.9 months).
Tumor subtype influences the metastatic behavior and survival after development of distant metastases.
探讨乳腺癌亚型对转移性行为和长期结果（定义为乳腺癌特异性生存）的影响。
这是一项回顾性单中心横断面研究，纳入了 5972 例于 2000 年至 2010 年间诊断为单侧首发乳腺癌的新诊断患者。患者要么接受早期乳腺癌（EBC）的主要手术治疗（SURG，n=5072），要么接受新辅助系统治疗（NEO，n=592），要么直接患有转移性疾病（META，n=308）。根据经典病理标准定义替代乳腺癌亚型。使用 Kaplan-Meier 方法和逻辑/ Cox 回归进行分析。
中位随访时间为 103.6 个月（IQR：73.4-139.2 个月）后，817 例 EBC 患者（14.4%）发生远处转移，其中 621 例（12.2%）为 SURG 患者，196 例（33.1%）为 NEO 患者。EBC 后的转移率如下：LuminalA 8.1%，LuminalB1（HER2-）20.4%，LuminalB2（HER2+）无（新）辅助曲妥珠单抗治疗者 21.7%，LuminalB2（HER2+）应用曲妥珠单抗者 9.0%，HER2 阳性（ER-）无曲妥珠单抗治疗者 30.0%，HER2 阳性（ER-）应用曲妥珠单抗者 19.9%，三阴性 25.3%。根据亚型，首次转移部位存在显著差异。对于单部位首次转移，从转移时间开始评估的乳腺癌特异性生存的中位值最差为脑转移（13.9 个月），最佳为骨转移（48.4 个月）。多部位首次转移的乳腺癌特异性生存从转移日期开始比单部位首次转移更差（1 个部位转移的中位值为 40.0 个月，2 个部位转移为 27.1 个月，≥3 个部位转移为 20.5 个月）。与 EBC 后的继发转移相比，直接转移性疾病的转移后从转移日期开始的中位乳腺癌特异性生存时间更长（43.4 个月 vs. 27.9 个月）。
肿瘤亚型影响远处转移后的转移行为和生存。
