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Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia.
World Journal of Surgical Oncology ( IF 3.2 ) Pub Date : 2020-05-30 , DOI: 10.1186/s12957-020-01893-w
Sumadi Lukman Anwar 1 , Widya Surya Avanti 2 , Andreas Cahyo Nugroho 1 , Lina Choridah 2 , Ery Kus Dwianingsih 3 , Wirsma Arif Harahap 4 , Teguh Aryandono 1 , Wahyu Wulaningsih 5
Affiliation  

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. 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. 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). 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.

中文翻译:

不同乳腺癌亚型患者术后远处转移的危险因素:印度尼西亚的一家医院研究。

超过三分之一的乳腺癌患者(包括那些在早期阶段被诊断出的患者)将发生远处转移。根据分子亚型,远处转移的模式和相关风险尚未完全揭示,特别是在诊断延迟和晚期的患者人群中。对我院(2014–2017年)收治的乳腺癌患者(n = 1304)进行了评估,以确定其转移模式和相关风险。在诊断中发现转移性乳腺癌的患者为245例(18.7%),在中位随访3.8年后将1059例患者分为非转移和转移组。肿瘤向皮肤和胸壁的浸润是远处转移的最有力预测因子(OR 2.115,95%CI 1.544–2。898),尤其是管腔A型亚型(OR 2.685,95%CI 1.649–4.371)。淋巴结转移也与远处转移的风险显着相关(OR 1.855,95%CI 1.319-2.611),而Luminal A样亚型的风险更高(OR 2.572,95%CI 1.547-4.278)。发光A样亚型的骨转移风险显着较高(OR 1.601,95%CI 1.106–2.358)。在治疗方面,与基于蒽环类药物的化疗相比,基于蒽环类药物和紫杉烷类药物的联合化疗与较低的远处器官扩散显着相关(OR 0.510,95%CI 0.355–0.766),并且在类似Luminal A的患者中疗效更强亚型(OR 0.417,95%CI 0.226–0.769)。分为Luminal和非Luminal亚型显示Luminal亚型的骨转移风险显着较高(OR 1.793,95%CI 1。209–2.660)和非淋巴瘤乳腺癌的肺转移(OR 1.445,95%CI 1.003–2.083)。除了指导治疗计划外,对包括分子亚型在内的临床病理变量进行全面分析还可以帮助确定乳腺癌患者远处转移的风险。我们的研究为乳腺癌亚型远处转移的风险提供了新的见解,以便计划进行强化监视或逐步升级治疗,尤其是在主要诊断为晚期患者的情况下。对包括分子亚型在内的临床病理变量的全面分析可以帮助确定乳腺癌患者远处转移的风险。我们的研究为乳腺癌亚型远处转移的风险提供了新的见解,以便计划进行强化监视或逐步升级治疗,尤其是在主要诊断为晚期患者的情况下。对包括分子亚型在内的临床病理变量的全面分析可以帮助确定乳腺癌患者远处转移的风险。我们的研究为乳腺癌亚型远处转移的风险提供了新的见解,以便计划进行强化监视或逐步升级治疗,尤其是在主要诊断为晚期患者的情况下。
更新日期:2020-05-30
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