Archives of Gynecology and Obstetrics

, Volume 295, Issue 1, pp 211–223 | Cite as

Pattern of metastatic spread and subcategories of breast cancer

  • Catharina Bartmann
  • Manfred Wischnewsky
  • Tanja Stüber
  • Roland Stein
  • Mathias Krockenberger
  • Sebastian Häusler
  • Wolfgang Janni
  • Rolf Kreienberg
  • Maria Blettner
  • Lukas Schwentner
  • Achim Wöckel
  • Joachim Diessner
Gynecologic Oncology



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 2 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.


Breast cancer Metastatic pattern Metastatic spread Breast cancer subtypes BRENDA 



We express our thanks to the following persons for their contributions to the BRENDA study: Karsten Gnauert (Ostalbklinikum, Aalen), Steffen Fritz (Kreisklinik Biberach), Ulf Göretzlehner (Kreiskrankenhaus Ehingen), Hans-Walter Vollert (Städt. Krankenhaus Friedrichshafen), Peter Jakob Albert (Klinikum Heidenheim), Ricardo Felberbaum (Klinikum Kempten), Andreas Zorr (Klinikum Konstanz), Felix Flock (Klinikum Memmingen), Erik Schlicht (Stauferklinik, Mutlangen), Martina Gropp-Meier (Oberschwabenklinik Ravensburg), Gerhard Bartzke (Kreiskrankenhaus Rottweil), Andreas Rempen (Diakonie-Krankenhaus, Schwäbisch Hall), Edgar Schelble (Kreiskrankenhaus Sigmaringen), Theodor Dinkelacker (Helfenstein-Klinik Geislingen), Andreas Grüneberger (Oberschwabenklinik Wangen) and Thorsten Kühn (Städt. Kliniken, Esslingen).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The Ethics Committee of the University of Ulm, which covers all participating breast cancer centers of the BRENDA network, has approved this study and the BRENDA project.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding source

This work was supported by the German Federal Ministry of Education and Research (BMBF-Grant-01ZP0505).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Catharina Bartmann
    • 1
  • Manfred Wischnewsky
    • 3
  • Tanja Stüber
    • 1
  • Roland Stein
    • 1
  • Mathias Krockenberger
    • 1
  • Sebastian Häusler
    • 1
  • Wolfgang Janni
    • 2
  • Rolf Kreienberg
    • 2
  • Maria Blettner
    • 4
  • Lukas Schwentner
    • 2
  • Achim Wöckel
    • 1
  • Joachim Diessner
    • 1
  1. 1.Department for Obstetrics and GynecologyUniversity Hospital of WürzburgWürzburgGermany
  2. 2.Department for Obstetrics and GynecologyUniversity Hospital of UlmUlmGermany
  3. 3.Faculty of Mathematics and Computer ScienceUniversity of BremenBremenGermany
  4. 4.Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI)University of MainzMainzGermany

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