Margot Van Mechelen1, Anke Van Herck1, Kevin Punie2,3,4, Ines Nevelsteen2, Ann Smeets2, Patrick Neven2, Caroline Weltens2, Sileny Han2, Adriaan Vanderstichele2, Giuseppe Floris2,5,6, Jean-Pierre Lobelle7, Hans Wildiers8,9,10. 1. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium. 2. Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium. 3. Department of General Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. 4. Department of Oncology, KU Leuven, Leuven, Belgium. 5. Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research and University Hospitals Leuven, Leuven, Belgium. 6. Department of Pathology, KU Leuven, Leuven, Belgium. 7. Consultant in Statistics, Beernem, Belgium. 8. Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium. hans.wildiers@uzleuven.be. 9. Department of General Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. hans.wildiers@uzleuven.be. 10. Department of Oncology, KU Leuven, Leuven, Belgium. hans.wildiers@uzleuven.be.
Abstract
PURPOSE: To explore the impact of breast cancer subtype on metastatic behavior and long-term outcome defined as breast cancer specific survival (BCSS). METHODS: Retrospective single centre cross-sectional study of 5972 patients with newly diagnosed, unilateral first diagnosis of breast cancer, diagnosed 2000-2010. Patients had either early breast cancer (EBC) treated primarily by surgery (SURG n = 5072), neoadjuvant systemic therapy (NEO n = 592), or upfront metastatic disease (META n = 308). Surrogate breast cancer subtypes were defined according to classical pathological criteria. Analysis was performed using Kaplan-Meier method and logistic/Cox regression. RESULTS: After median follow-up time of 103.6 months (IQR 73.4-139.2 months), 817 patients with EBC at diagnosis (14.4%) developed distant metastases of which 621 (12.2%) SURG and 196 (33.1%) NEO. Metastasis rate after EBC was: LuminalA 8.1%, LuminalB1(HER2-) 20.4%, LuminalB2(HER2+) without (neo)adjuvant trastuzumab 21.7%, LuminalB2(HER2+) with trastuzumab 9.0%, HER2Positive(ER-) without trastuzumab 30.0%, HER2Positive(ER-) with trastuzumab 19.9% and TripleNegative 25.3%. There were major differences in site of first metastases according to subtype. For single site first metastases, median BCSS assessed from time of metastases was worst for brain localization (13.9 months) and best for bone (48.4 months). Multiple sites of first metastases had worse BCSS from date of metastases than single site first metastases (median BCSS for 1 site 40.0, 2 sites 27.1, ≥ 3 sites 20.5 months). Median BCSS from date of metastases is longer in upfront metastases compared to secondary metastases after EBC (43.4 vs. 27.9 months). CONCLUSIONS: Tumor subtype influences the metastatic behavior and survival after development of distant metastases.
PURPOSE: To explore the impact of breast cancer subtype on metastatic behavior and long-term outcome defined as breast cancer specific survival (BCSS). METHODS: Retrospective single centre cross-sectional study of 5972 patients with newly diagnosed, unilateral first diagnosis of breast cancer, diagnosed 2000-2010. Patients had either early breast cancer (EBC) treated primarily by surgery (SURG n = 5072), neoadjuvant systemic therapy (NEO n = 592), or upfront metastatic disease (META n = 308). Surrogate breast cancer subtypes were defined according to classical pathological criteria. Analysis was performed using Kaplan-Meier method and logistic/Cox regression. RESULTS: After median follow-up time of 103.6 months (IQR 73.4-139.2 months), 817 patients with EBC at diagnosis (14.4%) developed distant metastases of which 621 (12.2%) SURG and 196 (33.1%) NEO. Metastasis rate after EBC was: LuminalA 8.1%, LuminalB1(HER2-) 20.4%, LuminalB2(HER2+) without (neo)adjuvant trastuzumab 21.7%, LuminalB2(HER2+) with trastuzumab 9.0%, HER2Positive(ER-) without trastuzumab 30.0%, HER2Positive(ER-) with trastuzumab 19.9% and TripleNegative 25.3%. There were major differences in site of first metastases according to subtype. For single site first metastases, median BCSS assessed from time of metastases was worst for brain localization (13.9 months) and best for bone (48.4 months). Multiple sites of first metastases had worse BCSS from date of metastases than single site first metastases (median BCSS for 1 site 40.0, 2 sites 27.1, ≥ 3 sites 20.5 months). Median BCSS from date of metastases is longer in upfront metastases compared to secondary metastases after EBC (43.4 vs. 27.9 months). CONCLUSIONS: Tumor subtype influences the metastatic behavior and survival after development of distant metastases.
Entities:
Keywords:
Breast cancer subtype; Disease free survival; Disease specific survival; Metastatic breast cancer; Trastuzumab
Authors: Janik Puttemans; Yana Dekempeneer; Jos L Eersels; Heleen Hanssens; Pieterjan Debie; Marleen Keyaerts; Albert D Windhorst; Frank van der Aa; Quentin Lecocq; Karine Breckpot; Alfred Morgenstern; Frank Bruchertseifer; Tony Lahoutte; Nick Devoogdt; Matthias D'Huyvetter Journal: Cancers (Basel) Date: 2020-04-21 Impact factor: 6.639