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New insights into breast microcalcification for poor prognosis: NACT cohort and bone metastasis evaluation cohort

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Abstract

Objectives

The study aimed to analyze the poor prognosis of microcalcification in breast cancer (BC), including the pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) and the risk of bone metastases.

Materials and methods

313 breast cancer patients received NACT to evaluate pCR and 1182 patients from a multicenter database to assess bone metastases were retrospectively included. Two groups were divided according to the presence or absence of mammography microcalcification. Clinical data, image characteristics, neoadjuvant treatment response, bone involvement, and follow-up information were recorded. The pCR and bone metastases were compared between subgroups using the Mann–Whitney and χ2 tests and logistic regression, respectively.

Results

Mammographic microcalcification was associated with a lower pCR than uncalcified BC in the NACT cohort (20.6% vs 31.6%, P = 0.029). Univariate and multivariate analysis suggested that calcification was a risk factor for poor NACT response [OR = 1.780, 95%CI (1.065–2.974), P = 0.028], [OR = 2.352, 95%CI (1.186–4.667), P = 0.014]. Microcalcification was more likely to be necrosis on MRI than those without microcalcification (53.0% vs 31.7%, P < 0.001), multivariate analysis indicated that tumor necrosis was also a risk factor for poor NACT response [OR = 2.325, 95%CI (1.100–4.911), P = 0.027]. Age, menopausal status, breast density, mass, molecular, and pathology type were not significantly associated with non-pCR risk assessment. In a multicenter cohort of 1182 patients with pathologically confirmed BC, those with microcalcifications had a higher proportion of bone metastases compared to non-calcified BC (11.6% vs 4.9%, P < 0.001). Univariate and multivariate analysis showed that microcalcification was an independent risk factor for bone metastasis [OR = 2.550, 95%CI (1.620–4.012), P < 0.001], [OR = 2.268(1.263–4.071), P = 0.006)]. Osteolytic bone metastases predominated but there was no statistical difference between the two groups (78.9% vs 60.7%, P = 0.099). Calcified BC was mainly involved in axial bone, but was more likely to involve the whole-body bone than non-calcified BC (33.8% vs 10.7%, P = 0.021).

Conclusion

This study provides important insights into the poor prognosis of microcalcification, not only in terms of poor response to NACT but also the risk factor of bone metastases.

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Data availability

This paper involved data from the internal studies of our institutions, which are not publicly available to protect patient privacy. Further inquiries can be directed to the corresponding author.

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Acknowledgements

We thank all the members of the institution for their help in discussions and for providing technical assistance.

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The funder played no role in determining the content of the manuscript or in the decision regarding whether to submit the manuscript for publication.

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Author notes

  1. Yangling Hu and Lijuan Mao have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Yangling Hu, Lijuan Mao, Mengyi Wang, Meizhi Li, Chaoyang Wang, Lin Ji & Xiaoling Zhang

  2. Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Hui Zeng

  3. Department of Radiology, The Panyu Fifth Hospital, Guangzhou, China

    Zhenqiu Li

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  1. Yangling Hu
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Contributions

YH and LM contributed to data management and designed the research. MW, ZL, ML, CW, and LJ contributed to software use, imaging processing, and methodology. XZ contributed to pathology analysis. YH writing the original manuscript. HZ and XZ reviewed and edited the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Hui Zeng or Xiaoling Zhang.

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Conflict of interest

The authors declare no competing financial or non-financial interests.

Ethical approval

This study involved human participants were reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-Sen University (No.2020–536) and Southern Hospital of Southern Medical University (NFEC-201706-K3-01) and waived written informed consent.

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Hu, Y., Mao, L., Wang, M. et al. New insights into breast microcalcification for poor prognosis: NACT cohort and bone metastasis evaluation cohort. J Cancer Res Clin Oncol 149, 7285–7297 (2023). https://doi.org/10.1007/s00432-023-04668-4

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  • DOI: https://doi.org/10.1007/s00432-023-04668-4

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