Skip to main content

Advertisement

SpringerLink
Log in

Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 06 January 2017

Abstract

Purpose

To analyze the prognostic influence of metastatic pattern (MP) compared with other biologic and clinical factors in stage IV breast cancer at initial diagnosis (BCID) and evaluate factors associated with specific sites of metastases (SSM).

Methods

We evaluated women with stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results program from 2010 to 2013. MP was categorized as bone-only, visceral, bone and visceral (BV), and other. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with SSM.

Results

We included 9143 patients. Bone represented 37.5% of patients, visceral 21.9%, BV 28.8%, and other 11.9%. Median OS by MP was as follows: bone 38 months, visceral 21 months, BV 19 months, and other 33 months (P < 0.0001). Univariate analysis showed that higher number of metastatic sites had worse prognosis. In multivariate analysis, older age (hazard ratio 1.9), black race (hazard ratio 1.17), grade 3/4 tumors (hazard ratio 1.6), triple-negative (hazard ratio 2.24), BV MP (hazard ratio 2.07), and unmarried patients (hazard ratio 1.25) had significantly shorter OS. As compared with HR+/HER2− tumors, triple-negative and HR−/HER2+ had higher odds of brain, liver, lung, and other metastases. HR+/HER2+ had higher odds of liver metastases. All three subtypes had lower odds of bone metastases.

Conclusions

There were substantial differences in OS according to MP. Tumor subtypes have a clear influence among other factors on SSM. We identified several prognostic factors that could guide therapy selection in treatment naïve patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA 66(1):31–42. doi:10.3322/caac.21320

    PubMed  Google Scholar 

  2. Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Perez JE, Machiavelli M, Rodriguez R, Alvarez LA (1988) Stage IV breast cancer: clinical course and survival of patients with osseous versus extraosseous metastases at initial diagnosis. The GOCS (Grupo Oncologico Cooperativo del Sur) experience. Am J Clin Oncol 11(6):618–622

    Article  CAS  PubMed  Google Scholar 

  3. Perez JE, Machiavelli M, Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Rodriguez R, Cuevas MA, Alvarez LA (1990) Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Grupo Oncologico Cooperativo del Sur. Am J Clin Oncol 13(4):294–298

    Article  CAS  PubMed  Google Scholar 

  4. Hortobagyi GN, Smith TL, Legha SS, Swenerton KD, Gehan EA, Yap HY, Buzdar AU, Blumenschein GR (1983) Multivariate analysis of prognostic factors in metastatic breast cancer. J Clin Oncol 1(12):776–786

    CAS  PubMed  Google Scholar 

  5. Hess KR, Varadhachary GR, Taylor SH, Wei W, Raber MN, Lenzi R, Abbruzzese JL (2006) Metastatic patterns in adenocarcinoma. Cancer 106(7):1624–1633. doi:10.1002/cncr.21778

    Article  PubMed  Google Scholar 

  6. Largillier R, Ferrero JM, Doyen J, Barriere J, Namer M, Mari V, Courdi A, Hannoun-Levi JM, Ettore F, Birtwisle-Peyrottes I, Balu-Maestro C, Marcy PY, Raoust I, Lallement M, Chamorey E (2008) Prognostic factors in 1,038 women with metastatic breast cancer. Ann Oncol 19(12):2012–2019. doi:10.1093/annonc/mdn424

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Lonning PE, Borresen-Dale AL (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98(19):10869–10874. doi:10.1073/pnas.191367098

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Smid M, Wang Y, Zhang Y, Sieuwerts AM, Yu J, Klijn JG, Foekens JA, Martens JW (2008) Subtypes of breast cancer show preferential site of relapse. Cancer Res 68(9):3108–3114. doi:10.1158/0008-5472.CAN-07-5644

    Article  CAS  PubMed  Google Scholar 

  9. Kennecke H, Yerushalmi R, Woods R, Cheang MC, Voduc D, Speers CH, Nielsen TO, Gelmon K (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28(20):3271–3277. doi:10.1200/JCO.2009.25.9820

    Article  PubMed  Google Scholar 

  10. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data+Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973-2013 varying)—Linked To County Attributes—Total U.S., 1969–2014 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2016, based on the November 2015 submission

  11. Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80(6):827–841

    Article  CAS  PubMed  Google Scholar 

  12. Murtaza M, Dawson SJ, Pogrebniak K, Rueda OM, Provenzano E, Grant J, Chin SF, Tsui DW, Marass F, Gale D, Ali HR, Shah P, Contente-Cuomo T, Farahani H, Shumansky K, Kingsbury Z, Humphray S, Bentley D, Shah SP, Wallis M, Rosenfeld N, Caldas C (2015) Multifocal clonal evolution characterized using circulating tumour DNA in a case of metastatic breast cancer. Nat Commun 6:8760. doi:10.1038/ncomms9760

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang Y, Waters J, Leung ML, Unruh A, Roh W, Shi X, Chen K, Scheet P, Vattathil S, Liang H, Multani A, Zhang H, Zhao R, Michor F, Meric-Bernstam F, Navin NE (2014) Clonal evolution in breast cancer revealed by single nucleus genome sequencing. Nature 512(7513):155–160. doi:10.1038/nature13600

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Andre F, Slimane K, Bachelot T, Dunant A, Namer M, Barrelier A, Kabbaj O, Spano JP, Marsiglia H, Rouzier R, Delaloge S, Spielmann M (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22(16):3302–3308. doi:10.1200/JCO.2004.08.095

    Article  PubMed  Google Scholar 

  15. Dawood S, Broglio K, Ensor J, Hortobagyi GN, Giordano SH (2010) Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol 21(11):2169–2174. doi:10.1093/annonc/mdq220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Pal SK, Dehaven M, Nelson RA, Onami S, Hsu J, Waliany S, Kruper L, Mortimer J (2012) Impact of modern chemotherapy on the survival of women presenting with de novo metastatic breast cancer. BMC Cancer 12:435. doi:10.1186/1471-2407-12-435

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lobbezoo DJ, van Kampen RJ, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FP, van Riel JM, Peters NA, de Boer M, Peer PG, Tjan-Heijnen VC (2015) Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer? Br J Cancer 112(9):1445–1451. doi:10.1038/bjc.2015.127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sherry MM, Greco FA, Johnson DH, Hainsworth JD (1986) Metastatic breast cancer confined to the skeletal system. An indolent disease. Am J Med 81(3):381–386

    Article  CAS  PubMed  Google Scholar 

  19. Ren Z, Li Y, Hameed O, Siegal GP, Wei S (2014) Prognostic factors in patients with metastatic breast cancer at the time of diagnosis. Pathol Res Pract 210(5):301–306. doi:10.1016/j.prp.2014.01.008

    Article  CAS  PubMed  Google Scholar 

  20. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL, Geradts J, Cheang MC, Nielsen TO, Moorman PG, Earp HS, Millikan RC (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502. doi:10.1001/jama.295.21.2492

    Article  CAS  PubMed  Google Scholar 

  21. Savci-Heijink CD, Halfwerk H, Hooijer GK, Horlings HM, Wesseling J, van de Vijver MJ (2015) Retrospective analysis of metastatic behaviour of breast cancer subtypes. Breast Cancer Res Treat 150(3):547–557. doi:10.1007/s10549-015-3352-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dawood S, Broglio K, Buzdar AU, Hortobagyi GN, Giordano SH (2010) Prognosis of women with metastatic breast cancer by HER2 status and trastuzumab treatment: an institutional-based review. J Clin Oncol 28(1):92–98. doi:10.1200/JCO.2008.19.9844

    Article  CAS  PubMed  Google Scholar 

  23. Lobbezoo DJ, van Kampen RJ, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FP, van Riel JM, Peters NA, de Boer M, Borm GF, Tjan-Heijnen VC (2013) Prognosis of metastatic breast cancer subtypes: the hormone receptor/HER2-positive subtype is associated with the most favorable outcome. Breast Cancer Res Treat 141(3):507–514. doi:10.1007/s10549-013-2711-y

    Article  CAS  PubMed  Google Scholar 

  24. Harrell JC, Prat A, Parker JS, Fan C, He X, Carey L, Anders C, Ewend M, Perou CM (2012) Genomic analysis identifies unique signatures predictive of brain, lung, and liver relapse. Breast Cancer Res Treat 132(2):523–535. doi:10.1007/s10549-011-1619-7

    Article  CAS  PubMed  Google Scholar 

  25. De Lena M, Romero A, Rabinovich M, Leone B, Vallejo C, Machiavelli M, Cuevas M, Rodriguez R, Lacava J, Perez J et al (1993) Metastatic pattern and DNA ploidy in stage IV breast cancer at initial diagnosis. Relation to response and survival. Am J Clin Oncol 16(3):245–249

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina

    Bernardo Amadeo Leone, Carlos Teodoro Vallejo, Alberto Omar Romero, Mario Raúl Machiavelli, Juan Eduardo Pérez & Julieta Leone

  2. University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA

    José Pablo Leone

  3. University of Iowa Hospitals and Clinics, C32 GH. 200 Hawkins Drive, Iowa City, IA, 52242, USA

    José Pablo Leone

Authors
  1. Bernardo Amadeo Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Teodoro Vallejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Omar Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Raúl Machiavelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Eduardo Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julieta Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José Pablo Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Pablo Leone.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leone, B.A., Vallejo, C.T., Romero, A.O. et al. Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis. Breast Cancer Res Treat 161, 537–548 (2017). https://doi.org/10.1007/s10549-016-4066-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-016-4066-7

Keywords

Search

Navigation