Pattern of metastatic spread in triple-negative breast cancer
Pattern of metastatic spread in triple-negative breast cancer
复制标题
DOI：
10.1007/s10549-008-0086-2
复制
发表时间：
2009-05-01
影响因子：
3.8
通讯作者：
Narod, Steven A.
中科院分区：
文献类型：
--
作者：
Dent, Rebecca;Hanna, Wedad M.;Narod, Steven A.
目的 与患有其他乳腺癌亚型的女性相比，患有三阴性乳腺癌（定义为雌激素受体阴性、孕激素受体阴性和 HER2/neu 阴性的癌症）的女性预后较差。有人提出，复发率的根本差异可能部分是由不同的转移扩散途径来解释的。实验设计 我们研究了 1608 名乳腺癌患者的队列，这些患者于 1987 年 1 月至 1997 年 12 月期间在多伦多女子学院医院诊断。三阴性乳腺癌被定义为雌激素受体阴性、孕激素受体阴性和 HER2/neu 阴性的乳腺癌。我们比较了患有三阴性乳腺癌和其他形式乳腺癌的女性骨转移和其他（非骨）器官转移的发生率。结果 1,608 名患者中，180 名（11.2%）患有三阴性乳腺癌。对 1608 名女性进行了中位随访 9.0 年（范围 0.1-19 年）。与其他患者相比，三阴性乳腺癌患者在研究期间远处复发的可能性增加（调整后的风险比（HR）1.9；95% CI：1.5-2.5，P < 0.0001）。诊断后五年内预后相对较差（HR 2.9；95% CI：2.1-3.9；P = 0.0001），但此后则不然（HR 0.5；95% CI：0.2-1.1；P = 0.07）。特别是，患有三阴性乳腺癌的女性在诊断后五年内发生内脏转移的可能性是其他类型癌症女性的四倍（HR 4.0；95% CI：2.7-5.9；P < 0.0001）。在此期间，三阴性癌症和其他形式的癌症的骨转移率相当（HR 0.8；95% CI：0.4-1.6 P = 0.5）。结论 与其他形式的癌症相比，三阴性乳腺癌远处复发的风险较高，很大程度上归因于诊断后头五年内内脏转移过多。
Purpose The prognosis of women with triple-negative breast cancers (defined as cancers that are estrogen receptor-negative, progesterone receptor-negative and HER2/neu negative) is poor, compared to women with other subtypes of breast cancer. It is proposed that the underlying difference in recurrence rates may be explained in part by different routes of metastatic spread. Experimental design We studied a cohort of 1608 patients diagnosed with breast cancer, diagnosed between January 1987 and December 1997 at Women's College Hospital in Toronto. Triple-negative breast cancers were defined as those that were estrogen receptor-negative, progesterone receptor-negative and HER2/neu-negative. We compared the incidence rates of metastatic spread to bone and to other (non-bone) organs in women with triple-negative and other forms of breast cancer. Results Of the 1,608 patients, 180 (11.2%) had triple-negative breast cancer. The 1608 women were followed for a median of 9.0 years (range 0.1-19 years). Compared to other patients, those with triple-negative breast cancer had an increased likelihood of distant recurrence over the study period (adjusted hazard ratio (HR) 1.9; 95% CI: 1.5-2.5, P < 0.0001). The relatively poor prognosis was apparent in the five years after diagnosis (HR 2.9; 95% CI: 2.1-3.9; P = 0.0001) but not thereafter (HR 0.5; 95% CI: 0.2-1.1; P = 0.07). In particular, women with triple-negative breast cancer were four times more likely to experience a visceral metastasis within five years of diagnosis than those with other types of cancer (HR 4.0; 95% CI: 2.7-5.9; P < 0.0001). The rates of bone metastases were comparable for triple-negative and for other forms of cancer in this time period (HR 0.8; 95% CI: 0.4-1.6 P = 0.5). Conclusions The excess risk of distant recurrence in triple-negative breast cancers, versus other forms of cancer, is attributable in large part to an excess of visceral metastases in the first five years following diagnosis.