Single Positive Hormone Receptor:Clinicopathologic And Prognosis In Stage Ⅳ Breast Cancer With Negative HER-2

Background.In recent years,breast cancer patients with single hormone receptor(HR)positive have been valued and considered to have independent characteristics and prognosis.In the de novo metastasis breast cancer patients,the metastasis site and prognosis are related to the molecular subtype of breast cancer.At present,there is rare relevant report to explore the clinicopathological and prognostic characteristics of different single-hormone receptor subtypes of metastatic breast cancer.In this study,we analyzed the differences of metastasis site and prognosis,and the risk factors influencing on prognosis in stage Ⅳ patients with human epidermal growth factor receptor-2 negative(HER-2 receptor).Methods.This study analyzed the clinicopathological characteristics of HER-2 negative breast cancer patients in SEER database from 2010 to 2015.At the same time,we explored different metastatic patterns and prognosis in different molecular subtypes(estrogen receptor(ER)+/progesterone receptor(PR)+,ER+/PR-,ER-/PR+,ER-/PR-).Multivariate regression analysis was used to analyze the risk factors of bone metastasis and visceral metastasis in all patients.Cox multivariate regression analysis was used to analyze the influence of single hormone receptor positive on the prognosis of patients in different subgroup and the risk factors affecting the prognosis of patients with single hormone receptor positive.Results.We included 206187 women diagnosed with invasive breast cancer,including 7726 patients with stage Ⅳ breast cancer.Patients with ER+/PR+ and ER+/PR-stage Ⅳ breast cancer were most likely to suffer bone metastasis(2,767,54.62%)(540,48.30%)and had better overall survival(OS)and breast cancer specific survival(BCSS).In ER-/PR+ breast cancer,lung metastasis was the metastasis site with highest proportion(25,26.88%).Bone metastasis(360,24.84%)and lung metastasis(336,23.19%)accounted for higher proportions in patients with breast cancer(TNBC).The loss of ER was the protective factor of bone metastasis(p < 0.001),and the risk factor of visceral metastasis(p < 0.001).Multivariate Cox regression analysis showed that elderly patients(HR = 2.16),higher histological grade(HR = 2.36),larger primary mass(T4: HR = 3.24),more lymph node metastasis(> 10: HR = 4.33),distant metastasis(HR = 4.99),no chemotherapy or unknown(HR = 1.65)were the high risk factors for breast cancer specific survival in ER-/PR+ patients.All kinds of surgical interventions(HR < 0.5)were protective factors for tumor specific survival.Conclusions.Single hormone receptor positive metastatic breast cancer has unique clinicopathological characteristics,metastasis model and prognosis characteristics.The absence of ER receptor may lead to more prone to visceral metastasis and reduce the survival rate of patients.For ER-/PR+ breast cancer patients,their survival characteristics and metastasis patterns are more similar to TNBC.Chemotherapy may improve cancer specific survival rate.