title: Features of aggressive breast cancer.
abstract: BACKGROUND
  Aggressive breast cancer is a term commonly used in literature to describe breast cancer with a poor prognosis. Identifying and understanding the factors associated with aggressiveness could be helpful to the management of patients with breast cancer. Breast cancer is a heterogeneous disease, both clinically and biologically, which may be responsible for the wide range of survival durations for patients with metastatic disease.
  
  
  OBJECTIVE
  The goal of this study was to identify the factors most often described in association with aggressive metastatic breast cancer (MBC).
  
  
  METHODS
  A systematic review was performed by querying PubMed from January 1, 2012 to June 1, 2014 for "metastatic breast cancer" ("aggressive" or "poor prognosis" or "high risk"). The level of evidence to support each potential prognostic factor of aggressive MBC was also reviewed.
  
  
  RESULTS
  The identified factors were grouped into 3 principle categories: clinical, biological, and patient related. Because patient-related factors may not be indicative of inherent cancer aggressiveness, this review focused only on clinical and biological factors. The factors with the highest levels of evidence to support associations with survival in metastatic breast cancer were visceral metastases, number of metastatic sites, disease-free interval, presence of CTCs, triple-negative disease, and tumour grade.
  
  
  CONCLUSIONS
  Identification of these factors and understanding their contribution to the aggressiveness of MBC and disease progression may lead to more personalized treatment in this patient population.
authors.affiliation: Università di Napoli Federico II, Napoli, Italy. Electronic address: grazia.arpino@unina.it.
authors.forename: Grazia
authors.initials: G
authors.lastname: Arpino
authors.affiliation: Università di Napoli Federico II, Napoli, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Milano
authors.affiliation: Università di Napoli Federico II, Napoli, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: De Placido
mesh_terms: D000008:Abdominal Neoplasms / Q000556:secondary*; D001932:Brain Neoplasms / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D009360:Neoplastic Cells, Circulating; D064726:Triple Negative Breast Neoplasms / Q000473:pathology*; D047368:Tumor Burden
keywords: Aggressive breast cancer; Biological features; Breast cancer; Clinical features; Metastatic breast cancer; Prognostic factors