Breast Cancer Research and Treatment

, Volume 141, Issue 3, pp 507–514 | Cite as

Prognosis of metastatic breast cancer subtypes: the hormone receptor/HER2-positive subtype is associated with the most favorable outcome

  • Dorien J. A. Lobbezoo
  • Roel J. W. van Kampen
  • Adri C. Voogd
  • M. Wouter Dercksen
  • Franchette van den Berkmortel
  • Tineke J. Smilde
  • Agnes J. van de Wouw
  • Frank P. J. Peters
  • Johanna M. G. H. van Riel
  • Natascha A. J. B. Peters
  • Maaike de Boer
  • George F. Borm
  • Vivianne C. G. Tjan-HeijnenEmail author


Contrary to the situation in early breast cancer, little is known about the prognostic relevance of the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) in metastatic breast cancer. The objectives of this study were to present survival estimates and to determine the prognostic impact of breast cancer subtypes based on HR and HER2 status in a recent cohort of metastatic breast cancer patients, which is representative of current clinical practice. Patients diagnosed with metastatic breast cancer between 2007 and 2009 were included. Information regarding patient and tumor characteristics and treatment was collected. Patients were categorized in four subtypes based on the HR and HER2 status of the primary tumor: HR positive (+)/HER2 negative (−), HR+/HER2+, HR−/HER2+ and triple negative (TN). Survival was estimated using the Kaplan–Meier method. Cox proportional hazards model was used to determine the prognostic impact of breast cancer subtype, adjusted for possible confounders. Median follow-up was 21.8 months for the 815 metastatic breast cancer patients included; 66 % of patients had the HR+/HER2− subtype, 8 % the HR−/HER2+ subtype, 15 % the TN subtype and 11 % the HR+/HER2+ subtype. The longest survival was observed for the HR+/HER2+ subtype (median 34.4 months), compared to 24.8 months for the HR+/HER2− subtype, 19.8 months for the HR−/HER2+ subtype and 8.8 months for the TN subtype (P < 0.0001). In the multivariate analysis, subtype was an independent prognostic factor, as were initial site of metastases and metastatic-free interval. The HR+/HER2+ subtype was associated with the longest survival after diagnosis of distant metastases.


Breast cancer Distant metastases Subtypes Prognosis Survival 



This work was supported by the Netherlands Organization for Health Research and Development (Grant Number ZonMw: 80-82500-98-8003).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Dorien J. A. Lobbezoo
    • 1
    • 2
  • Roel J. W. van Kampen
    • 1
  • Adri C. Voogd
    • 1
  • M. Wouter Dercksen
    • 2
  • Franchette van den Berkmortel
    • 3
  • Tineke J. Smilde
    • 4
  • Agnes J. van de Wouw
    • 5
  • Frank P. J. Peters
    • 6
  • Johanna M. G. H. van Riel
    • 7
  • Natascha A. J. B. Peters
    • 8
  • Maaike de Boer
    • 1
  • George F. Borm
    • 9
  • Vivianne C. G. Tjan-Heijnen
    • 1
    Email author
  1. 1.Maastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Máxima Medical CenterEindhovenThe Netherlands
  3. 3.Atrium Medical Center ParkstadHeerlenThe Netherlands
  4. 4.Jeroen Bosch HospitalDen BoschThe Netherlands
  5. 5.VieCuri Medical CenterVenloThe Netherlands
  6. 6.Orbis Medical CenterSittardThe Netherlands
  7. 7.St Elisabeth HospitalTilburgThe Netherlands
  8. 8.St Jans HospitalWeertThe Netherlands
  9. 9.Radboud University Medical CenterNijmegenThe Netherlands

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