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. 2020 Apr;19(4):2884-2894.
doi: 10.3892/ol.2020.11359. Epub 2020 Jan 30.

De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Li Zhang  1 , Zhijun Li  1 , Jie Zhang  1 , Yansheng Wu  2 , Yuying Zhu  1 , Zhongsheng Tong  1
Affiliations

De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Li Zhang et al. Oncol Lett. 2020 Apr.

Abstract

The purpose of the present study was to analyze the clinical and pathological characteristics, treatment, and prognosis of de novo metastatic breast cancer (DnMBC). Information regarding 1,890 patients treated for advanced breast cancer at the Tianjin Medical University Cancer Hospital between January 2008 to December 2017 was collected. Clinicopathological characteristics, treatments and outcomes of these patients were compared using the chi-square test, log-rank test, and Cox regression analysis. A total of 171 patients were diagnosed with DnMBC. The median age at diagnosis was 53 years (range, 23-77). The percentage of T4 staging was higher (37.4%), 69.6% of patients were estrogen receptor (ER) positive, 59.1% were progesterone receptor positive, 29.8% had positive human epidermal growth factor receptor 2 (HER2) status, 68.4% had Ki-67 ≥20%, 55% had oligometastasis at the initial diagnosis, ~87.7% were treated with chemotherapy initially and 24% received palliative surgery for the primary tumor. After a median follow-up time of 26 months, the median progression-free survival (PFS) and overall survival (OS) among patients with DnMBC were 11 (8.7-13.3) months and 34 (27.9-40.1) months, respectively. In the multivariable model, ER status and sites of first metastasis (oligometastasis or polymetastasis) were identified to be independent predictors of PFS (P<0.05); ER status, primary tumor stage, and surgical treatment of primary tumors were identified to be independent predictors of OS (P<0.05). In conclusion, the clinicopathological characteristics of DnMBC are greater invasiveness and a higher risk of progression. Palliative surgical treatment may improve the prognosis of HR+/HER2-patients with oligometastasis. Therefore, individualized treatment as required is particularly important.

Keywords: breast cancer; clinicopathological characteristics; de novo metastatic; primary tumor surgery; prognosis; subtypes.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier survival curves for PFS and OS of patients with de novo metastatic breast cancer. The Kaplan-Meier (A) PFS and (B) OS curves of patients. PFS, progression free survival; OS, overall survival; CI, confidence interval.
Figure 2.
Figure 2.
Distribution, and PFS and OS curves of patients with DnMBC, based on different subtypes. (A) The percentage of different subtypes in patients with DnMBC. The Kaplan-Meier (B) PFS and (C) OS curves of patients based on different subtypes. PFS, progression free survival; OS, overall survival; DnMBC, de novo metastatic breast cancer; CI, confidence interval; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; n/N, number of incidents/total number.
Figure 3.
Figure 3.
Distribution, and PFS and OS curves of patients with DnMBC, based on different sites of first metastasis. (A) The percentage of different sites of first metastasis in patients with DnMBC. The Kaplan-Meier (B) PFS and (C) OS curves of patients based on different sites of first metastasis. DnMBC, de novo metastatic breast cancer; PFS, progression free survival; OS, overall survival; CI, confidence interval; n/N, number of incidents/total number.
Figure 4.
Figure 4.
Distribution, and PFS and OS curves of patients with DnMBC, based on surgical treatment for primary tumor. (A) The percentage of surgical treatment for primary tumor in patients with DnMBC. The Kaplan-Meier (B) PFS and (C) OS curves of patients based on surgical treatment for primary tumor. DnMBC, de novo metastatic breast cancer; PFS, progression free survival; OS, overall survival; CI, confidence interval; n/N, number of incidents/total number.
Figure 5.
Figure 5.
OS curves of patients with de novo metastatic breast cancer, based on different molecular subtypes and surgical treatment. (A) HR+/HER2- subgroup, (B) HR±/HER2+ subgroup and (C) HR-/HER2- subgroup. OS, overall survival; CI, confidence interval; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; n/N, number of incidents/total number.
Figure 6.
Figure 6.
OS curves of patients with de novo metastatic breast cancer, based on site of first metastasis and surgical treatment. (A) Oligometastasis subgroup and (B) Polymetastasis subgroup. OS, overall survival; CI, confidence interval; n/N, number of incidents/total number.
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