Analysis Of The Correlation Between The First Metastatic Organ,Clinical Characteristics,and Molecular Subtypes Of Invasive Ductal Carcinoma Of The Breast

Objective: To explore the relationship between the first metastatic organ,clinical characteristics,and molecular subtypes of invasive ductal carcinoma of the breast.Methods: Follow up 4900 patients with breast cancer admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2000 to December 2020.Retrospective analysis was conducted on 1175 patients with primary metastasis of invasive ductal carcinoma of the breast who met the inclusion and exclusion criteria.Pearson chi square test was used to analyze and compare the differences of different recurrence and metastasis sites and the distribution of different molecular types in different clinical indicator groups of primary metastasis of invasive ductal carcinoma of the breast,Using a logistic regression model to analyze the influencing factors on the first metastasis tumor free survival rate of invasive ductal carcinoma of the breast Results:(1)The results of this study showed that the incidence of distant lymph node metastasis(neck and supraclavicular)was 119 cases(41.5%)at the age of ≤ 39 years old,and the incidence of lung metastasis was 75 cases(34.7%)above 60 years old.In the first metastasis of invasive ductal carcinoma of the breast,the proportion of lesions originating in the outer upper quadrant is the highest(698 cases,59.5%).Statistics show that the local recurrence rate of invasive ductal carcinoma of the breast in the inner lower quadrant is the highest,while the liver metastasis in the outer lower quadrant is the highest.In this study,the lower the histological grade,the higher the incidence of distant lymph node metastasis,the higher the histological grade,the higher the incidence of local recurrence and organ metastasis,and the higher the risk of hematogenous metastasis.In this study,it was found that the highest incidence rates of ER(+),HER-2(-)clavicle,and cervical lymph nodes were 111 cases(41.0%)and 326 cases(36.8%),respectively.The PR(+)group(66 cases,34.6%)and HER-2(-)group(88 cases,30.4%)were more prone to lung metastasis,while ER(-)and PR(-)were more prone to liver metastasis,while HER-2(+)was more prone to lung metastasis.In this study,we found that patients with invasive ductal carcinoma of the breast experienced distant lymph node metastasis and lung metastasis in the early stage(within 5 years)after treatment,with a high incidence of liver and bone metastasis after 10 years.The results of this study showed that Luminal B type and Luminal A type had the highest incidence of distant lymph node metastasis,with 57cases(45.2%)and 46 cases(38.3%),respectively.Luminal A type was more prone to bone metastasis.The HER-2 overexpression type has the highest incidence of local recurrence and lung metastasis,while the triple negative type is more prone to liver metastasis.(2)The initial metastasis of Luminal type invasive ductal carcinoma of the breast is mostly in elderly patients.In the initial metastasis of invasive ductal carcinoma of the breast,HER-2overexpression type primary tumors have a larger diameter,more lymph node metastasis,and higher histological grading.In the analysis of clinical case characteristics,it was found that among patients with histological grade I,the proportion of triple negative type was the highest(89 cases,68.5%).(3)Multivariate analysis of 3-year,5-year,and 10-year tumor free survival rates in patients with first metastasis of invasive ductal carcinoma of the breast showed that the location of the primary tumor had a significant impact on prognosis regardless of 3,5,and 10 years.Tumors in the outer lower quadrant and inner upper quadrant were risk factors for tumor metastasis.The number of axillary lymph node metastases,histological grade,and HER-2 are related factors that affect the 5-year tumor free survival rate,while the 10-year tumor free survival rate is only affected by the location of the primary tumor and the number of axillary lymph node metastases.Conclusion: The initial metastasis of invasive ductal carcinoma of the breast is mostly triple negative,while Luminal type is prone to distant lymph node metastasis,with Luminal A type relatively prone to bone metastasis.HER-2 overexpression type has a higher proportion of lung metastasis,while triple negative type is prone to liver metastasis for the first time.HER-2 overexpression breast infiltrating ductal carcinoma with larger masses,more lymph node metastases,and higher histological grading is prone to first-time metastasis and may require enhanced treatment.The location of the tumor shows significant prognostic differences in the first metastasis of invasive ductal carcinoma of the breast,which is an important factor affecting its tumor free survival.