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Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

BACKGROUND: More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patient...

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Autores principales: Anwar, Sumadi Lukman, Avanti, Widya Surya, Nugroho, Andreas Cahyo, Choridah, Lina, Dwianingsih, Ery Kus, Harahap, Wirsma Arif, Aryandono, Teguh, Wulaningsih, Wahyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261382/
https://www.ncbi.nlm.nih.gov/pubmed/32473643
http://dx.doi.org/10.1186/s12957-020-01893-w
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author Anwar, Sumadi Lukman
Avanti, Widya Surya
Nugroho, Andreas Cahyo
Choridah, Lina
Dwianingsih, Ery Kus
Harahap, Wirsma Arif
Aryandono, Teguh
Wulaningsih, Wahyu
author_facet Anwar, Sumadi Lukman
Avanti, Widya Surya
Nugroho, Andreas Cahyo
Choridah, Lina
Dwianingsih, Ery Kus
Harahap, Wirsma Arif
Aryandono, Teguh
Wulaningsih, Wahyu
author_sort Anwar, Sumadi Lukman
collection PubMed
description BACKGROUND: More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages. METHODS: Breast cancer patients (n = 1304) admitted to our institute (2014–2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years. RESULTS: Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544–2.898) particularly in the luminal A-like subtype (OR 2.685, 95% CI 1.649–4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319–2.611), and the risk was higher in the Luminal A-like subtype (OR 2.572, 95% CI 1.547–4.278). Luminal A-like subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106–2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355–0.766) and the effect was stronger in Luminal A-like subtype (OR 0.417, 95% CI 0.226–0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209–2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003–2.083). CONCLUSION: In addition to guiding the treatment plan, a comprehensive analysis of clinicopathological variables including the molecular subtypes could assist in the determination of distant metastasis risks of breast cancer patients. Our study offers new perspectives concerning the risks of distant metastasis in breast cancer subtypes in order to plan intensive surveillance or escalation of treatment particularly in a setting where patients are predominantly diagnosed in late stages.
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spelling pubmed-72613822020-06-07 Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia Anwar, Sumadi Lukman Avanti, Widya Surya Nugroho, Andreas Cahyo Choridah, Lina Dwianingsih, Ery Kus Harahap, Wirsma Arif Aryandono, Teguh Wulaningsih, Wahyu World J Surg Oncol Research BACKGROUND: More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages. METHODS: Breast cancer patients (n = 1304) admitted to our institute (2014–2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years. RESULTS: Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544–2.898) particularly in the luminal A-like subtype (OR 2.685, 95% CI 1.649–4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319–2.611), and the risk was higher in the Luminal A-like subtype (OR 2.572, 95% CI 1.547–4.278). Luminal A-like subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106–2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355–0.766) and the effect was stronger in Luminal A-like subtype (OR 0.417, 95% CI 0.226–0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209–2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003–2.083). CONCLUSION: In addition to guiding the treatment plan, a comprehensive analysis of clinicopathological variables including the molecular subtypes could assist in the determination of distant metastasis risks of breast cancer patients. Our study offers new perspectives concerning the risks of distant metastasis in breast cancer subtypes in order to plan intensive surveillance or escalation of treatment particularly in a setting where patients are predominantly diagnosed in late stages. BioMed Central 2020-05-30 /pmc/articles/PMC7261382/ /pubmed/32473643 http://dx.doi.org/10.1186/s12957-020-01893-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Anwar, Sumadi Lukman
Avanti, Widya Surya
Nugroho, Andreas Cahyo
Choridah, Lina
Dwianingsih, Ery Kus
Harahap, Wirsma Arif
Aryandono, Teguh
Wulaningsih, Wahyu
Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title_full Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title_fullStr Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title_full_unstemmed Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title_short Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
title_sort risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in indonesia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261382/
https://www.ncbi.nlm.nih.gov/pubmed/32473643
http://dx.doi.org/10.1186/s12957-020-01893-w
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