De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis
De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis
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新发转移性乳腺癌：分子亚型和预后的亚组分析
DOI：
10.3892/ol.2020.11359
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发表时间：
2020-04-01
期刊：
影响因子：
2.9
通讯作者：
Tong, Zhongsheng
中科院分区：
文献类型：
--
作者：
Zhang, Li;Li, Zhijun;Tong, Zhongsheng
本研究旨在分析初发转移性乳腺癌的临床病理特点、治疗及预后。收集了2008年1月至2017年12月天津医科大学肿瘤医院收治的1890例晚期乳腺癌患者的信息。用卡方检验、对数等级检验和COX回归分析比较这些患者的临床病理特征、治疗方法和结果。共有171名患者被诊断为DnMBC。确诊时的中位年龄为53岁(范围23-77岁)。T4分期较高(37.4%)，雌激素受体(ER)阳性者占69.6%，孕激素受体阳性者占59.1%，人表皮生长因子受体2(HER2)阳性者占29.8%，Ki-67≥阳性者占68.4%，初诊时有少转移者占55%，初次化疗占87.7%，原发灶姑息性手术占24%。中位随访时间26个月，中位无进展生存期(PFS)为11(8.7~13.3)个月，总生存期(OS)为34(27.9~40.1)个月。在多变量模型中，ER状态和首次转移(少转移或多转移)的部位是PFS的独立预测因素(P<；0.05)；ER状态、原发肿瘤分期和原发肿瘤的手术治疗是OS的独立预测因素(P<；0.05)。总之，DnMBC的临床病理特征是侵袭性较大，进展风险较高。姑息性手术治疗可改善HR+/HER2-少转移患者的预后。因此，根据需要进行个体化治疗尤为重要。
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.