Thetendency Of Distant Metastasis In Different Subtypes Of Breast Cancer

Purpose:It is unclear whether different subtypes of breast cancer are associated with specific site metastasis.This study was to investigate the relationship between breast cancer subtypes and distant metastatic sites and time,and to provide a theoretical basis for guiding individualized treatment and prognosis.Methods:Retrospective analysis of patients with early-stage breast cancer,who were diagnosed in LiaoNing Provincial Cancer Hospital between 2008and 2013,and with complete follow-up data.According to the expression levels of hormone receptor(PR,ER)and human epidermal growth factor receptor 2(Her2)and Ki67of tumor tissue.The breast cancer was classified into four subtypes:Luminal A,Luminal B,Her2overexpression and triple negative(TN).Follow-up by telephone or consultation,analyze the clinical and pathological characteristics of different molecular subtypes,and the recurrence and metastasis of each molecular subtype were summarized.The recurrence and metastasis of each subtype were analyzed and summarized.The clinical and pathological features of different breast cancer subtypes were compared by X~2 test.The correlation between different molecular typing and recurrence and metastasis was analyzed by single factor and multifactor analysis.Results:496 cases of breast cancer had recurrence and metastasis,105 of them had local recurrence,and 391 cases were included.The age of the patients ranged from 22 to 80years,with an average age of 51 years and a median age of 52 years.According to the age of onset,the patients were divided into four groups(<35 years old,36-50 years old,and>50 years old).The age of onset of hormone receptor-positive patients was older than that of HER-2 and TN patients(P<0.05).Luminal B type was 47.6%,followed by TN type 25.6%,Luminal A type 18.9%,and HER2 positive patients at least 7.9%.By analyzing the differences of clinical pathological characteristics among different types of breast cancer,we found that there were significant differences in clinical stages among patients with different molecular subtypes of breast cancer.There was no significant difference in molecular typing between menopause,tumor size and number of lymph node metastases.Statistical results showed that 250 patients in T2 stage accounted for 63.9%,but there was no significant difference between T stage and molecular subtypes(P=0.081).There was no significant difference in N stage and axillary lymph node metastasis among patients with molecular subtypes(P>0.05).370patients underwent mastectomy,including modified radical mastectomy and radical mastectomy,while 21 patients underwent breast conserving surgery.Neoadjuvant chemotherapy,post-operative chemotherapy,radiotherapy and surgical procedures were not significantly different among the four molecular typing.There was significant difference between endocrine therapy and molecular typing(P<0.001)..Bone metastasis was found in 170 cases(43.5%),lung metastasis in 125cases(32%),liver metastasis in 70 cases(17.9%)and brain metastasis in 22 cases(5.6%).Luminal A and Luminal B had the most bone metastases,HER2 had the most lung and brain metastases,and TN had the most lung metastases.Multivariate COX regression model was used to analyze the differences of molecular typing among bone,liver,brain and lung in metastatic sites.Luminal A breast cancer was used as a reference.Results Molecular typing was an independent factor affecting distant metastasis sites.Kaplan-Meier was used to analyze the relationship between molecular typing of breast cancer and disease-free survival(DFS).Luminal A breast cancer had the best disease-free survival rate,and the other types were Luminal B,TN and HER2 breast cancer in turn.Log-rank test showed significant difference in disease-free survival among molecular typing groups(P<=0.005).Multivariate Cox regression model was used to analyze the influencing factors of disease-free survival of breast cancer.Results Molecular typing of breast cancer was an independent influencing factor of disease-free survival?Conclusions:Different molecular subtypes of breast cancer have a tendency in organ metastasis.Molecular typing is an independent prognostic factor for breast cancer disease-free survival and different organ metastasis.It can predict the time and location of metastasis in breast patients,and has important guiding significance for patient prognosis and clinical individualized follow-up and treatment.