title: Impact of breast cancer subtypes and patterns of metastasis on outcome.
abstract: Clinical outcome of patients with stage IV breast cancer is dependent on tumor biology, extent, and localization of metastases. Routine imaging diagnostics for distant metastasis is not recommended by the national guidelines for breast cancer follow-up. In this study, we evaluated different patterns of metastases of cancer subtypes in order to generate hypotheses on individualization of follow-up after breast cancer in the adjuvant setting. Patients of the Regional Breast Cancer Center Dresden diagnosed within the years 2006-2011 were classified into the five intrinsic subtypes luminal A (ER+, Her2-, G1/2), luminal B/Her2 negative (ER+, Her2-, G3), triple positive (ER+, PR+, Her2+), Her2-enriched (ER-, Her2+), and triple negative (ER-, PR-, Her2-) and with a median follow-up of 45 months. Tumor stage at time of first diagnosis of breast cancer as well as time and site of metastasis at first diagnosis of distant metastatic disease was analyzed. Tumor specimen of 2284 female patients with primary breast cancer was classified into five subtypes. Distant recurrence-free survival at 3 years was most unfavorable in Her2-enriched (66.8 %), triple negative (75.9 %), and triple-positive breast cancer (81.7 %). The same subtypes most frequently presented with visceral metastases only at first presentation: Her2-enriched 46.9 %, triple negative 45.5 %, and triple-positive breast cancer 37.5 %. Longest median survival of 2.3 years was seen in luminal A and in Her2-enriched metastatic disease, respectively. Median survival was significantly better in the luminal A, Her2-enriched, and triple-positive subtype compared to triple-negative breast cancer (p < 0.005). Differences in time to metastatic disease, first localization of metastases, and overall survival after diagnosis of metastatic disease were shown. Considering new targeted therapies and the option of surgery of oligometastases, screening for visceral metastases might be reasonable after diagnosis of Her2-positive subtypes.
authors.affiliation: Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany, karin.kast@uniklinikum-dresden.de.
authors.forename: Karin
authors.initials: K
authors.lastname: Kast
authors.forename: Theresa
authors.initials: T
authors.lastname: Link
authors.forename: Katrin
authors.initials: K
authors.lastname: Friedrich
authors.forename: Andrea
authors.initials: A
authors.lastname: Petzold
authors.forename: Antje
authors.initials: A
authors.lastname: Niedostatek
authors.forename: Olaf
authors.initials: O
authors.lastname: Schoffer
authors.forename: Carmen
authors.initials: C
authors.lastname: Werner
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
authors.forename: Andreas
authors.initials: A
authors.lastname: Werner
authors.forename: Axel
authors.initials: A
authors.lastname: Gatzweiler
authors.forename: Barbara
authors.initials: B
authors.lastname: Richter
authors.forename: Gustavo
authors.initials: G
authors.lastname: Baretton
authors.forename: Pauline
authors.initials: P
authors.lastname: Wimberger
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000145:classification* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor