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Pattern of metastasis and outcome in patients with breast cancer

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Abstract

There is growing evidence about differences in metastatic spread among breast cancer (BC) biologic subtypes (BS). Aim of this study was to analyze the pattern of metastasization according to BS and to explore the corresponding prognosis. A series of 544 consecutive patients receiving anticancer therapy for metastatic BC from 2004 to 2013, was analyzed. BS were defined by immunohistochemistry according to St Gallen 2013 criteria. Association between BS and the different distant localizations was analyzed. Prognosis was described in terms of overall survival (OS), progression free survival (PFS) and post progression survival (PPS). Results were reported taking luminal A BC as reference. Triple negative BC showed a higher tropism for lung (OR 4.30 95 % CI 1.41–13.1), while non luminal HER2 subtype was associated with a higher rate of liver metastases (OR 3.61 95 % CI 1.36–9.58). All subtypes were associated with a lower risk of bone-only localization. Central nervous system (CNS) involvement was more common in HER2 positive BC (OR 6.3, 95 % CI 1.08–36.66). Liver, lung and CNS involvement influenced negatively OS (HR 1.64, 95 % CI 1.29–2.07; HR 1.49, 95 % CI 1.18–1.90; HR 2.891, 95 % CI 1.85–4.51, respectively) and PFS (HR 1.39, 95 % CI 1.13–1.71; HR 1.26, 95 % CI 1.02–1.55; HR 1.75, 95 % CI 1.12–2.71, respectively). Multivariate analysis confirmed liver involvement as independent predictor of worse OS (HR 1.64, 95 % CI 1.15–2.34). Stratification by metastatic pattern showed significant differences in terms of PPS but not in terms of PFS. The study suggests that BS may be characterized by typical patterns of metastatic spread and have different impact on clinical outcome.

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References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90. doi:10.3322/caac.20107

    Article  PubMed  Google Scholar 

  2. Sihto H, Lundin J, Lundin M et al (2011) Breast cancer biological subtypes and protein expression predict for the preferential distant metastasis sites: a nationwide cohort study. Breast Cancer Res BCR 13:R87. doi:10.1186/bcr2944

    Article  CAS  Google Scholar 

  3. El Saghir NS, Tfayli A, Hatoum HA et al (2011) Treatment of metastatic breast cancer: state-of-the-art, subtypes and perspectives. Crit Rev Oncol Hematol 80:433–449. doi:10.1016/j.critrevonc.2011.01.010

    Article  PubMed  Google Scholar 

  4. Bonotto M, Gerratana L, Poletto E et al (2014) Measures of outcome in metastatic breast cancer: insights from a real-world scenario. Oncologist 19:608–615. doi:10.1634/theoncologist.2014-0002

    Article  PubMed  Google Scholar 

  5. Khodari W, Sedrati A, Naisse I et al (2013) Impact of loco-regional treatment on metastatic breast cancer outcome: a review. Crit Rev Oncol Hematol 87:69–79. doi:10.1016/j.critrevonc.2012.12.005

    Article  CAS  PubMed  Google Scholar 

  6. Redig AJ, McAllister SS (2013) Breast cancer as a systemic disease: a view of metastasis. J Intern Med 274:113–126. doi:10.1111/joim.12084

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Kennecke H, Yerushalmi R, Woods R et al (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28:3271–3277. doi:10.1200/JCO.2009.25.9820

    Article  PubMed  Google Scholar 

  8. Berman AT, Thukral AD, Hwang W-T et al (2013) Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment. Clin Breast Cancer 13:88–94. doi:10.1016/j.clbc.2012.11.001

    Article  PubMed  Google Scholar 

  9. Park S, Koo JS, Kim MS et al (2012) Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry. Breast 21:50–57. doi:10.1016/j.breast.2011.07.008

    Article  PubMed  Google Scholar 

  10. Lam SW, Jimenez CR, Boven E (2014) Breast cancer classification by proteomic technologies: current state of knowledge. Cancer Treat Rev 40:129–138. doi:10.1016/j.ctrv.2013.06.006

    Article  CAS  PubMed  Google Scholar 

  11. Goldhirsch A, Winer EP, Coates AS et al (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann Oncol 24:2206–2223. doi:10.1093/annonc/mdt303

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Prat A, Cheang MCU, Martín M et al (2013) Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal A breast cancer. J Clin Oncol 31:203–209. doi:10.1200/JCO.2012.43.4134

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Park YH, Lee S, Cho EY et al (2010) Patterns of relapse and metastatic spread in HER2-overexpressing breast cancer according to estrogen receptor status. Cancer Chemother Pharmacol 66:507–516. doi:10.1007/s00280-009-1190-7

    Article  CAS  PubMed  Google Scholar 

  14. Minisini AM, Moroso S, Gerratana L et al (2013) Risk factors and survival outcomes in patients with brain metastases from breast cancer. Clin Exp Metastasis. doi:10.1007/s10585-013-9594-5

    PubMed  Google Scholar 

  15. Metzger-Filho O, Sun Z, Viale G et al (2013) Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: results from international breast cancer study group trials VIII and IX. J Clin Oncol 31:3083–3090. doi:10.1200/JCO.2012.46.1574

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Puglisi F, Fontanella C, Numico G et al (2014) Follow-up of patients with early breast cancer: is it time to rewrite the story? Crit Rev Oncol Hematol 91:130–141. doi:10.1016/j.critrevonc.2014.03.001

    Article  PubMed  Google Scholar 

  17. Heitz F, Harter P, Lueck H-J et al (2009) Triple-negative and HER2-overexpressing breast cancers exhibit an elevated risk and an earlier occurrence of cerebral metastases. Eur J Cancer Oxf Engl 45:2792–2798. doi:10.1016/j.ejca.2009.06.027

    Article  CAS  Google Scholar 

  18. Dawood S, Broglio K, Ensor J et al (2010) Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol 21:2169–2174. doi:10.1093/annonc/mdq220

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Yardley DA, Kaufman PA, Brufsky A et al (2014) Treatment patterns and clinical outcomes for patients with de novo versus recurrent HER2-positive metastatic breast cancer. Breast Cancer Res Treat 145:725–734. doi:10.1007/s10549-014-2916-8

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Oncology, University Hospital of Udine, Piazzale S.M. Misericordia, 33100, Udine, Italy

    L. Gerratana, V. Fanotto, M. Bonotto, S. Bolzonello, A. M. Minisini, G. Fasola & F. Puglisi

  2. Department of Medical and Biological Sciences, University of Udine, Udine, Italy

    L. Gerratana & F. Puglisi

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  1. L. Gerratana
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  2. V. Fanotto
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  3. M. Bonotto
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  4. S. Bolzonello
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  5. A. M. Minisini
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  6. G. Fasola
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  7. F. Puglisi
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Correspondence to F. Puglisi.

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Gerratana, L., Fanotto, V., Bonotto, M. et al. Pattern of metastasis and outcome in patients with breast cancer. Clin Exp Metastasis 32, 125–133 (2015). https://doi.org/10.1007/s10585-015-9697-2

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  • DOI: https://doi.org/10.1007/s10585-015-9697-2

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