Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis
Incidence proportions and prognosis of breast cancer patients with bone metastases at initial diagnosis
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DOI：
10.1002/cam4.1668
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发表时间：
2018-08-01
期刊：
影响因子：
4
通讯作者：
Shao, Zhi-Ming
中科院分区：
文献类型：
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作者：
Gong, Yue;Zhang, Jing;Shao, Zhi-Ming
简介：目前关于乳腺癌诊断时骨转移的发生率和预后的基于人群的数据有限。因此，我们进行本研究来分析癌症诊断时乳腺癌骨转移患者的发病比例和预后因素。 材料和方法：利用监测、流行病学和最终结果（SEER）数据集和复旦大学附属肿瘤医院（FUSCC）队列对2010年至2014年间初诊时患有原发性浸润性乳腺癌和骨转移的患者进行识别。进行多变量逻辑回归以确定诊断时骨转移存在的预测因素。进行单变量和多变量分析以确定每个变量对生存的影响。 结果：在 SEER 数据库中纳入分析的 195 名患者中，有 229 名患者中，8295 名患者在初次诊断时出现骨转移，占整个研究人群的 3.6%，占患有任何远处部位转移的亚组的 65.1%。激素受体（HR）阳性、人表皮生长因子受体2（HER2）阴性的患者在转移性疾病患者中发生率最高（73.9%）。在整个队列中，多变量逻辑回归确定了八个因素作为诊断时骨转移存在的预测因素。 SEER 和 FUSCC 队列中骨转移患者的中位 OS 分别为 30.0 个月和 68.2 个月。 HR 阳性 HER2 阳性亚型患者的中位 OS 最长，三阴性亚型患者的中位 OS 最短。 SEER 队列中的多变量 Cox 模型证实年龄、组织学、分级、肿瘤亚型、骨外转移部位、初次手术史、保险状况、婚姻状况和收入是 OS 和 BCSS 的独立预后因素。结论：本研究的结果为初次诊断乳腺癌时骨转移患者的发病率和预后提供了基于人群的估计。
Introduction: Population-based data on the incidence and prognosis of bone metastases at diagnosis of breast cancer are currently limited. Hence, we conducted this study to analyze the incidence proportions and prognostic factors of patients with breast cancer and bone metastases at the time of cancer diagnosis.Materials and methods: Patients with primary invasive breast cancer and bone metastases at initial diagnosis between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results (SEER) dataset and Fudan University Shanghai Cancer Center (FUSCC) cohort. Multivariable logistic regression was performed to identify predictors of the presence of bone metastases at diagnosis. Univariate and multivariate analyses were performed to determine the effects of each variable on survival.Results: Of 229, 195 patients from SEER database included in the analysis, 8295 patients had bone metastases at initial diagnosis, reflecting 3.6% of the entire study population, and 65.1% of the subset with metastatic disease to any distant site. Patients with hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative represented the highest incidence proportions among patients with metastatic disease (73.9%). Among entire cohort, multivariable logistic reeression identified eight factors as predictors of the presence of bone metastases at diagnosis. Median OS for the patients with bone metastases in SEER and FUSCC cohorts was 30.0 and 68.2 months, respectively. Patients with HR-positive HER2-positive subtype had the longest median OS, and patients with triple-negative subtype showed the shortest median OS. Multivariable Cox model in SEER cohort confirmed age, histology, grade, tumor subtype, extraosseous metastatic sites, history of primary surgery, insurance status, marital status, and income as independent prognostic factors for both OS and BCSS.Conclusions: The findings of this study provide population-based estimates of the incidence and prognosis for patients with bone metastases at initial diagnosis of breast cancer.