Characteristics and survival in bone metastatic breast cancer patients with different hormone receptor status: A population-based cohort study

Abstract

BackgroundAccumulating preclinical evidence has uncovered the indispensable role of steroid hormone and their receptors, namely, estrogen receptor (ER) and progesterone receptor (PR), in the development of bone metastases in breast cancer. Limited data are available regarding the survival difference between different hormone receptor (HR) subgroups, and its prognostic significance is uncertain now. Such data are important for risk stratification and needed to formulate specialized regimen for bone metastatic breast cancer.MethodsFrom the year of diagnosis 2010 to 2018, 554,585 breast cancer patients, among which are 19,439 with bone metastasis and 10,447 with bone-only metastasis, were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier survival analysis was performed to compare the survival difference between the different HR status subgroups. Univariate and multivariate Cox proportional hazard regression was used to validate the prognostic role of HR status and identify other prognostic factors in bone metastatic breast cancer.ResultsER-positive/PR-positive breast cancer patients with bone metastasis showed the best breast cancer-specific survival (BCSS) and overall survival (OS) than those with other HR statuses, while single PR-positive bone metastatic breast cancers manifest similar survival with ER-negative/PR-negative ones. Adjusted Cox regression analysis demonstrated that patients with older age, male, black race, ILC, higher tumor grade, T3–T4, HER2-negative status, absence of surgery or adjuvant treatment, and HR status other than ER-positive/PR-positive tended to have worse outcomes. Further subgroup analysis based on HER2 status showed that within HER2-positive breast cancers, ER-positive/PR-positive ones still manifest better survival than the other three HR status subgroups, which are similar in survival outcomes.ConclusionAlthough collectively viewed as HR-positive breast cancers, certain distinctions exist between bone metastatic breast cancers with different HR statuses in survival outcome. Our findings indicate that despite metastasizing to the same location, the different survival rate is determined by the HR status of breast cancer. The selection and intensity of the regimen should consider HR status, and HER2 status occasionally, when treating bone metastatic breast cancer.

Syngeneic mouse model of human HER2+ metastatic breast cancer for the evaluation of trastuzumab emtansine combined with oncolytic rhabdovirus

“…While it cannot substitute for human trials, we believe the 4T1.2-HER2T model developed in this study has characteristics of high-grade “HER2+” mBC characteristic of Stage IV human mBC ( 31 , 32 ), and can be a useful tool to complement and overcome many limitations of existing transgenic and xenograft models.…”

Higher rate of progesterone receptor positivity in skeletal metastases of breast cancer with a pathological fracture vs those without fracture

“…19 Metastatic breast cancer can cause the destruction of the normal skeletal structure and function, resulting in skeletal-related events, including severe bone pain, pathological bone fracture, spinal cord compression and hypercalcemia, which may lead to reduced quality of life and survival. 20 Under normal circumstances, bone metabolism is a well-balanced process between osteoblasts and osteoclasts, regulated by various cytokines and steroid sex hormones, including estrogen and progesterone. 21 Disrupted levels of these hormones together with their downstream receptor signaling may lead to an abnormal bone composition and facilitate the development of SM.…”

Non-operative complete consolidation of a juxta-articular metastatic acetabular bone lesion in oestrogen receptor-positive metastatic breast cancer

“…Metastatic bone disease from breast cancer could be successfully treated with medication only, even when it is located close to the articular cartilage in weight-bearing areas. Non-operative treatment may stabilise and biomechanically improve the lytic bone lesions without jeopardising the integrity and function of the affected joints 1 2…”