Impact of breast cancer subtypes and patterns of metastasis on outcome
Impact of breast cancer subtypes and patterns of metastasis on outcome
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DOI：
10.1007/s10549-015-3341-3
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发表时间：
2015-04-01
影响因子：
3.8
通讯作者：
Wimberger, Pauline
中科院分区：
文献类型：
--
作者：
Kast, Karin;Link, Theresa;Wimberger, Pauline
IV期乳腺癌患者的临床结局取决于肿瘤生物学、范围和转移部位。国家乳腺癌随访指南不推荐对远处转移进行常规影像学诊断。在这项研究中，我们评估了癌症亚型的不同转移模式，以产生关于乳腺癌辅助治疗后个体化随访的假设。德累斯顿地区乳腺癌中心在2006-2011年诊断的患者被分为五种固有亚型管腔A型，（ER+、Her 2-、G1/2），管腔B/Her 2阴性在一个实施方案中，患者的年龄为20岁至30岁（ER+、Her 2-、G3）、三重阳性（ER+、PR+、Her 2+）、Her 2富集（ER-、Her 2+）和三重阴性（ER-、PR-、Her 2-），中位随访时间为45个月。分析首次诊断乳腺癌时的肿瘤分期以及首次诊断远处转移性疾病时的转移时间和部位。将2284例女性原发性乳腺癌患者的肿瘤标本分为5个亚型。在Her 2富集（66.8%）、三阴性（75.9%）和三阳性乳腺癌（81.7%）中，3年无远处复发生存率最不利。相同的亚型仅在首次出现时最常出现内脏转移：Her 2富集型46.9%，三阴性45.5%，三阳性37.5%。最长的中位生存期为2.3年，分别见于管腔A和Her 2富集的转移性疾病。与三阴性乳腺癌相比，管腔A型、Her 2富集型和三阳性亚型的中位生存期显著更好（p < 0.005）。显示了转移性疾病的时间、首次转移灶定位和转移性疾病诊断后的总生存率的差异。考虑到新的靶向治疗和寡转移瘤的手术选择，在Her 2阳性亚型诊断后筛查内脏转移瘤可能是合理的。
Clinical outcome of patients with stage IV breast cancer is dependent on tumor biology, extent, and localization of metastases. Routine imaging diagnostics for distant metastasis is not recommended by the national guidelines for breast cancer follow-up. In this study, we evaluated different patterns of metastases of cancer subtypes in order to generate hypotheses on individualization of follow-up after breast cancer in the adjuvant setting. Patients of the Regional Breast Cancer Center Dresden diagnosed within the years 2006-2011 were classified into the five intrinsic subtypes luminal A (ER+, Her2-, G1/2), luminal B/Her2 negative (ER+, Her2-, G3), triple positive (ER+, PR+, Her2+), Her2-enriched (ER-, Her2+), and triple negative (ER-, PR-, Her2-) and with a median follow-up of 45 months. Tumor stage at time of first diagnosis of breast cancer as well as time and site of metastasis at first diagnosis of distant metastatic disease was analyzed. Tumor specimen of 2284 female patients with primary breast cancer was classified into five subtypes. Distant recurrence-free survival at 3 years was most unfavorable in Her2-enriched (66.8 %), triple negative (75.9 %), and triple-positive breast cancer (81.7 %). The same subtypes most frequently presented with visceral metastases only at first presentation: Her2-enriched 46.9 %, triple negative 45.5 %, and triple-positive breast cancer 37.5 %. Longest median survival of 2.3 years was seen in luminal A and in Her2-enriched metastatic disease, respectively. Median survival was significantly better in the luminal A, Her2-enriched, and triple-positive subtype compared to triple-negative breast cancer (p < 0.005). Differences in time to metastatic disease, first localization of metastases, and overall survival after diagnosis of metastatic disease were shown. Considering new targeted therapies and the option of surgery of oligometastases, screening for visceral metastases might be reasonable after diagnosis of Her2-positive subtypes.