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De novo metastasis in breast cancer: occurrence and overall survival stratified by molecular subtype

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Abstract

Breast cancer molecular subtypes, categorized jointly by hormone receptors (HR) and human epidermal growth factor-2 (HER2), are utilized to guide systemic therapy. We hypothesized distinct patterns of de novo metastasis and overall survival by molecular subtype using a retrospective cohort of 399,772 women in the National Cancer Database diagnosed with first primary invasive breast cancer between 2010 and 2014, of whom 13,924 were diagnosed with de novo metastasis from 2010 to 2013 and had follow up data. The relationship of molecular subtype with patient and tumor characteristics, including site of de novo metastasis, were examined using Chi-squared tests. Kaplan–Meier and Cox proportional hazards analyses were used to examine overall survival by molecular subtype. Bone was the most frequent de novo metastatic site for all molecular subtypes. Compared to HR+/HER2−, patients with HR−/HER2+ experienced 4.5, 3.0, and 6.0 times the de novo brain, lung, and liver metastasis respectively. In survival analyses of women diagnosed with de novo metastasis, the mortality risk relative to HR+/HER2− was twice as high for triple-negative (hazard ratio = 2.02, 95% CI 1.89–2.16) and modestly lower for HR+/HER2+ (hazard ratio = 0.83, 95% CI 0.78–0.88). The median survival difference between metastatic patients with and without chemotherapy was 28.6 months in HR+/HER2+ and 28.2 months in HR−/HER2+, but only 10.9 months in triple-negative and 5.2 months in HR+/HER2−. In conclusion, despite unfavorable patterns of de novo metastasis, HER2+ breast cancers had relatively better survival in recent years, probably due to treatment differences. Utilizing molecular subtype and site of de novo metastasis may predict prognosis and guide treatment.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CoC:

Commission on Cancer

CIs:

Confidence intervals

ER:

Estrogen receptor

HR:

Hormone receptor

HER2:

Human epidermal growth factor receptor 2-neu

ICD-O-3:

International Classification of Diseases for Oncology-Third edition

NCDB:

National Cancer Database

NH:

Non-Hispanic

OS:

Overall survival

PR:

Progesterone receptor

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Acknowledgements

This research was supported by Susan G. Komen® (GTDR16376189) and American Cancer Society (MRSG-13-063-01-TBG).

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Authors and Affiliations

  1. Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA

    David J. Press & Dezheng Huo

  2. Department of Surgery, Case Western Reserve University Hospitals, Cleveland, OH, USA

    Megan E. Miller

  3. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Erik Liederbach & Katherine Yao

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  1. David J. Press
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Correspondence to Dezheng Huo.

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Press, D.J., Miller, M.E., Liederbach, E. et al. De novo metastasis in breast cancer: occurrence and overall survival stratified by molecular subtype. Clin Exp Metastasis 34, 457–465 (2017). https://doi.org/10.1007/s10585-017-9871-9

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