Distribution and Prognosis of Metastatic Disease in Newly Diagnosed Stage IV Breast Cancer

X. Kong, Qiang Liu, R. Coleman, Yi Fang, Jing Wang
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Abstract

Background Thorough population-based estimates of the epidemiological features of metastatic disease in newly diagnosed stage IV breast cancer are lacking.

Methods Target patients were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to estimate the odds ratios (ORs) for different metastasis patterns (bone, brain, liver and lung), stratified by sociodemographic and clinicopathological variables. Survival estimates were performed using the Kaplan-Meier method and the Cox regression.

Results A total of 356789 patients with breast cancer were included of which 18036 (5.06%) had stage IV disease. Bone metastasis had the highest composition ratio (42.6%). Patients with HR-/HER2+ subtype had the highest metastasis at diagnosis incidence proportions (1310/15062 [8.7%] of the entire cohort). Female breast cancer patients were more susceptible to bone metastasis, lung metastasis, and liver metastasis than male patients (all P<0.01). Hispanics were the most likely to have brain metastases (P<0.01). Compared with other subtypes, HR-/HER2- patients was the most likely to have lung metastases. Patients with bone metastasis displayed the longest median survival (27 months). Among patients with brain or liver metastases, Grade III patients had the worst prognosis (P<0.01). Among patients with lung metastasis, infiltrating duct mixed with other types of carcinoma (IDM) had a better prognosis than infiltrating duct carcinoma (IDC) (P<0.01). For liver metastases, TNM N0 stage patients had the highest risk of death, followed by N2 (P<0.01).

Conclusion We believe this is the most comprehensive analysis of the distribution and prognosis of metastatic disease in newly diagnosed stage IV breast cancer. It lends support to consideration of further studies evaluating the utility of modern screening strategies of the bone, brain, liver and lung among patient subsets at high risk for metastasis.
新诊断的IV期乳腺癌转移灶的分布及预后
背景对新诊断的IV期乳腺癌转移性疾病的流行病学特征缺乏全面的基于人群的估计。方法使用监测、流行病学和最终结果(SEER)数据库确定目标患者。采用Logistic回归估计不同转移模式(骨、脑、肝和肺)的优势比(ORs),并按社会人口统计学和临床病理变量分层。使用Kaplan-Meier法和Cox回归进行生存估计。结果共纳入356789例乳腺癌患者,其中ⅳ期18036例(5.06%)。骨转移的构成比例最高(42.6%)。HR-/HER2+亚型患者在诊断时的转移发生率最高(占整个队列的1310/15062[8.7%])。女性乳腺癌患者更易发生骨转移、肺转移和肝转移(p < 0.01)。西班牙裔患者发生脑转移的可能性最大(P<0.01)。与其他亚型相比,HR-/HER2-患者最容易发生肺转移。骨转移患者的中位生存期最长(27个月)。在脑或肝转移患者中,III级患者预后最差(P<0.01)。在肺转移患者中,浸润性导管混合其他类型癌(IDM)预后优于浸润性导管癌(IDC) (P<0.01)。对于肝转移,TNM N0期患者死亡风险最高,N2期次之(P<0.01)。结论我们认为这是对新诊断的IV期乳腺癌转移灶分布和预后最全面的分析。它支持进一步研究评估骨、脑、肝和肺的现代筛查策略在转移高风险患者亚群中的效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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