Impact of molecular subtypes on metastatic behavior and overall survival in patients with metastatic breast cancer: A single‑center study combined with a large cohort study based on the Surveillance, Epidemiology and End Results database

Abstract

Breast cancer is a highly heterogeneous disease at the molecular level and >90% of mortalities are due to metastasis and its associated complications. The present study determined the impact of molecular subtypes on metastatic behavior and overall survival (OS) of patients with metastatic breast cancer. The influence of molecular subtypes on the sites and number of metastases in 166 patients with metastatic breast cancer from a single center were assessed; and the influence of molecular subtypes on the sites and number of metastases and OS in 15,322 metastatic cases among 329,770 patients with primary breast cancer from the Surveillance, Epidemiology and End Results database were assessed. Analysis of both datasets revealed that different molecular subtypes exhibited differences in the prevalence of different metastatic sites and number of metastases. A larger proportion of bone metastasis was observed in the hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)+ subtype than in other subtypes, more lung metastasis was observed in the HR-/HER2+ subtype and more liver metastasis occurred in the HR+/HER2+ and HR-/HER2+ subtypes. Single-site metastasis was more common for the HR+/HER2− subtype than in other subtypes, while 2–3 sites of metastases were more common for the HR+/HER2+ subtype and ≥4 sites of metastases were more frequent in the HR-/HER2+ and HR-/HER2- subtypes. The mean OS of patients with primary breast cancer in the HR+/HER2− subtype group was the longest (78.5 months), while the HR-/HER2- group had the shortest mean OS (69.1 months). The mean OS of the metastatic HR+/HER2+ group was the longest (46.0 months), while the mean OS of the metastatic HR-/HER2- group was the shortest (18.5 months). In conclusion, the results of the present study suggested that different molecular subtypes of breast cancer have different metastatic behavior, as well as mean OS.

Nomogram for predicting the risk of bone metastasis in breast cancer: a SEER population-based study

“…Yann Delpech published a model without molecular subtypes classification, but our prediction model made it more comprehensive ( 23 ). We identified that HR+/HER-2− subtypes and HR+/HER2+ subtypes were more susceptible to bone metastasis, which was consistent with the rule of subtypes distribution reported by Yang ( 24 ). HR−/HER-2+ and triple-negative breast cancer more often metastasize to visceral organs, it may explain that those patients have died of visceral metastases before bone metastases were noted ( 21 , 25 ).…”

Clinical Impact of FDG-PET/CT Compared with CE-CT in Response Monitoring of Metastatic Breast Cancer

“…Up to 70% of MBC patients experience bone involvement during their disease period [11], which is more common in hormone receptor-positive disease [12]. Bone lesions are hardly detected and monitored by CE-CT since active malignant lesions in the bones are difficult to distinguish from osteosclerotic recovering lesions [10,13,14].…”

Sympathetic activity in breast cancer and metastasis: partners in crime

“…Breast cancer exhibits specific tropism for organs such as the lung, brain, liver and bone, and there are indications that this tropism is associated with breast cancer receptor status 52 . Luminal A/B tumors are the most prevalent subtype in patients with breast cancer, and they mostly metastasize to bone 53 , 54 . Luminal A/B bone metastases are typically indolent in the first years of follow-up, and patients presenting only bone metastases have higher overall survival rates than patients presenting metastasis to other distant sites 53 , 54 .…”

“…Luminal A/B tumors are the most prevalent subtype in patients with breast cancer, and they mostly metastasize to bone 53 , 54 . Luminal A/B bone metastases are typically indolent in the first years of follow-up, and patients presenting only bone metastases have higher overall survival rates than patients presenting metastasis to other distant sites 53 , 54 . However, ~70% of all late-stage breast cancer patients exhibit bone metastatic foci leading to severe complications such as hypercalcemia, pain and bone fractures 52 , 55 .…”