The Characteristics And The Risk Of Recurrence And Metastasis For Women Newly Diagnosed With Advanced Breast Cancer In China

Objectives1.To describe the primary diagnosis and treatment status of advanced breast cancer in China and to investigate the differences among young patients and other patients.2.To investigate the primary diagnosis and treatment choices among patients of different molecular subtypes.3.To explore annual hazard of recurrence of different clinicopathologic groups and try to provide suggestions to improve the follow-up strategy.MethodsThis study was a hospital-based,multi-center retrospective clinical epidemiology study.We enrolled patients from 7 geographical areas from 21 hospitals during January 2012 to December 2014 and collect the clinical record information of them.The information of patients’ personal characteristics,primary diagnosis and treatment,recurrence diagnosis and treatment and the disease-free survival in order to summarize the clinical pathological characteristics of advanced breast cancer patients in China and explore the recurrence feature of different types of patients.Results1.The peak age of primary diagnosis of breast cancer was 40 to 50 year-old and the average age was younger in our study while about 15%were young patients.More than half patients were late stage at primary diagnosis in this study.Young patients had more proportion of younger age of menarche,childless and without history of breastfeeding.The mastectomy surgery was the dominant treatment and the most common adjuvant treatment was chemotherapy.2.The most common molecular subtype was HR+&HER2-,and HR+&HER2+was the second and the average age of these two subtypes patients were younger when primary diagnosis.The reproductive factors were distributed differently among four subtypes.The proportion of menopausal patients in HR-&HER2+group,the number of children in HR-&HER2-group were higher than other while the diagnosis age of patients in HER2+group was lower.About half patients with HR positive were not undergone adjuvant endocrine therapy.Varied recurrence feature occurred among four subtypes while HR+&HER2-patients were less likely to relapse or metastasis within 24 months and metastasis sites were also varied.HR positive patients were more likely to occur bone metastasis,HER2 overexpression patients more likely to have liver metastasis,HR negative patients more likely to have lung metastasis and the brain metastasis risk was lower in HR+&HER2+patients.3.Our study reveals a double peak time of annual hazard with the higher risk in the 3rd and 7th year after surgery while similar feature occurred in HR negative patients and HER2 overexpression patients.Older age,earlier menarche,earlier delivery age and older menopause age were risk factors of disease-free survival.ConclusionThe primary diagnosis age of advanced breast cancer was younger than other countries and other studies in China,and higher proportion of late stage was also found.The mastectomy surgery was the dominant treatment and the most common adjuvant treatment was chemotherapy.The annual hazard showing a double peak curve and the second peak zone had higher risk which reveals that the follow-up strategy should keep doing even those who had undergone surgery several years.Older diagnosis age,HR negative,HER2 overexpression,early menarche age,early delivery age and older menopausal age were risk factors of disease-free survival.