Breast carcinoma subtypes show different patterns of metastatic behavior
Breast carcinoma subtypes show different patterns of metastatic behavior
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DOI：
10.1007/s00428-017-2065-7
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发表时间：
2017-03-01
期刊：
影响因子：
3.5
通讯作者：
Tokes, Anna-Maria
中科院分区：
文献类型：
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作者：
Molnar, Istvan Artur;Molnar, Bela Akos;Tokes, Anna-Maria
我们回顾性研究的目的是分析亚型特异性转移扩散的模式并确定远处转移的时间进程。匈牙利第二病理科档案中确定了 2000 年至 2007 年间在匈牙利 Semmelweis 大学接受手术和术后治疗并被诊断出的连续 490 名乳腺癌患者。分子亚型是根据 2011 年圣加仑建议定义的。使用 Windows 版 SPSS Statistics 22.0 版进行统计分析。无远处转移生存期（DMFS）定义为肿瘤首次病理诊断与首次检测到远处转移之间所经过的时间。 124 名患者检测到远处转移。发生转移的平均时间为 29 个月（范围 0-127 个月）。 Luminal A (LUMA) 亚型的 DMFS 最长（平均 39 个月），而 HER2 阳性 (HER2+) 亚型的 DMFS 最短（平均 21 个月；p = 0.012）。我们证实 HER2+ 肿瘤发生远处转移的风险较高 (42.1%)。 59% 的病例中发现 LUMA 相关转移是单发性的，而 79.2% 的病例中 HER2+ 肿瘤显示出多发性转移。与 HER2+ 和三阴性乳腺癌 (TNBC) 病例相比，LUMA 肿瘤更倾向于仅骨转移，而后者的脑转移率更高。激素受体（HR）阳性肿瘤最常见的第二转移部位是肺和肝脏，而大脑是HR阴性（HR-）病例中受影响最严重的器官。肿瘤亚型的 DMFS 和远处转移模式有所不同。 HER2+ 肿瘤的临床病程最具侵袭性。进一步识别影响预后的亚型特异性因素可能会对临床护理和决策产生影响。
The aim of our retrospective study was to analyze patterns of subtype specific metastatic spread and to identify the time course of distant metastases. A consecutive series of 490 patients with breast cancer who underwent surgery and postoperative treatment at Semmelweis University, Hungary, and diagnosed between the years 2000 and 2007 was identified from the archives of the 2nd Department of Pathology, Hungary. Molecular subtypes were defined based on the 2011 St. Gallen recommendations. Statistical analysis was performed with SPSS Statistics for Windows, Version 22.0. Distant metastasis free survival (DMFS) was defined as the time elapsed between the first pathological diagnosis of the tumor and the first distant metastasis detection. Distant metastases were detected in 124 patients. Mean time to develop metastasis was 29 months (range 0-127 months). The longest DMFS was observed in the Luminal A (LUMA) subtype (mean 39 months) whereas the shortest was seen in the HER2positive (HER2+) subtype (mean 21 months; p = 0.012). We confirmed that HER2+ tumors carry a higher risk for distant metastases (42.1%). LUMA-associated metastases were found to be solitary in 59% of cases, whereas HER2+ tumors showed multiple metastases in 79.2% of cases. LUMAtumors showed a preference for bone-only metastasis as compared with HER2+ and triple negative breast cancer (TNBC) cases, which exhibited a higher rate of brain metastasis. The most frequent second metastatic sites of hormone receptor (HR) positive tumors were the lung and liver, whereas the brain was the most affected organ in HR-negative (HR-) cases. Tumor subtypes differ in DMFS and in pattern of distant metastases. HER2+ tumors featured the most aggressive clinical course. Further identification of subtype-specific factors influencing prognosis might have an impact on clinical care and decision-making.