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. 2025 Aug 5;5(1):333.
doi: 10.1038/s43856-025-01011-5.

A comprehensive evaluation of de novo metastatic breast cancer trends by subtype from the Dallas Metastatic Cancer Study

Hannah L Chang #  1   2   3 , Meng Cao #  1   4 , Mir Lim  1   4 , Anna Moscowitz  1   2 , Ang Gao  5 , Ariana Weiss  1   4 , Ariel Brown  1   4 , Danielle Spanbauer  1   4 , Giselle Uwera  1   4 , Jaeyoung Oh  1   4 , Jonathan Ladner  1   4 , Nathaniel Wu  1   4 , Priscilla Okanlawon  1   4 , Reynaldo Olivo  1   4 , Ruchita Iyer  1   4 , Yemariamwork Engidaw  1   4 , Sangeetha M Reddy  1   2 , Heather L McArthur  1   2 , Lily Xu  1   4 , Sakshi Mohta  1   4 , Julia Maues  6 , Christine Hodgdon  6 , Luis Chinea  1   4 , Katherine Lei  1   4 , Shao-Po Huang  1   4 , Rani Bansal  7 , Isaac S Chan  8   9   10   11
Affiliations

A comprehensive evaluation of de novo metastatic breast cancer trends by subtype from the Dallas Metastatic Cancer Study

Hannah L Chang et al. Commun Med (Lond). .

Abstract

Background: The Dallas Metastatic Cancer Study is a clinical database established to examine local trends associated with the diagnosis and treatment of de novo metastatic breast cancer and identify factors for further evaluation. Clinical characteristics of patients with de novo metastatic breast cancer are often underreported in the literature.

Methods: We report data from 2010 to 2021 for patients with de novo metastatic breast cancer along with the impact of clinical variables such as age, BMI, race and ethnicity, insurance status, hypertension, diabetes, and site of metastasis with survival analysis with respect to subtype.

Results: Black race (HR 2.07, 95% CI 1.56-2.74), public insurance (HR 1.64, 95% CI 1.23-2.18), no insurance (HR 1.69, 95% CI 1.24-2.31), hypertension (HR 1.50, 95% CI 1.18-1.91), diabetes (HR 1.69, 95% CI 1.24-2.31), and visceral metastases including brain (HR 1.68, 95% CI 1.20-2.36), liver (HR 1.80, 95% CI 1.40-2.30), and lung (HR 1.50, 95% CI 1.17-1.92) were associated with increased mortality and remained significant when controlled for subtype. In the multivariate analysis, diabetes (HR 1.74, 95% CI 1.22-2.49) and presence of liver metastases (HR 1.97, 95% CI 1.43-2.49) remained independently associated with decreased overall survival regardless of subtype and other variables. Patients diagnosed at 40 and younger were less likely to have hypertension and diabetes, more likely to be Hispanic, and showed distinct subtype distributions compared to those diagnosed at older ages.

Conclusions: Future work will focus on these associations at the patient level to identify targets for intervention.

Plain language summary

The Dallas Metastatic Cancer Study aims to better understand metastatic breast cancer by examining local trends in diagnosis and treatment. The study analyzed data from 2010 to 2021 and specifically focused on patients with a metastatic breast cancer diagnosis at first presentation. The study evaluated how factors such as age, BMI, race, insurance status, and co-existing medical conditions like hypertension and diabetes affected survival. The results show that Black patients, those with public or no insurance, those with specific metastases (i.e., liver, brain, lung) had worse survival outcomes. These outcomes underscore the areas where targeted interventions could improve patient outcomes.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow diagram for patient inclusion.
Patients were first identified as M0 vs non-M0 with all the M0 patients excluded from the study. Patients were then excluded based on selection criteria, including all patients without dnMBC and those with a diagnosis outside of the window. Patients were then excluded if they were not followed for at least one year after diagnosis (unless they reached mortality before the 1-year window).
Fig. 2
Fig. 2
Kaplan–Meier overall survival curve for the population in this study.
Fig. 3
Fig. 3
Kaplan–Meier survival curves for variables with significant differences.
See this image and copyright information in PMC

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