Impact of molecular subtypes on metastatic breast cancer patients: a SEER population-based study

Yue Gong, Yi-Rong Liu, Peng Ji, Xin Hu, Zhi-Ming Shao, Yue Gong, Yi-Rong Liu, Peng Ji, Xin Hu, Zhi-Ming Shao

Abstract

To investigate the significance and impact of molecular subtyping stratification on metastatic breast cancer patients, we identified 159,344 female breast cancer patients in the Surveillance, Epidemiology and End Results (SEER) database with known hormone receptor (HoR) and human epidermal growth factor receptor 2 (HER2) status. 4.8% of patients were identified as having stage IV disease, and were more likely to be HER2+/HoR-, HER2+/HoR+, or HER2-/HoR-. Stage IV breast cancer patients with a HER2+/HoR+ status exhibited the highest median overall survival (OS) (44.0 months) and those with a HER2-/HoR- status exhibited the lowest median OS (13.0 months). Patients with a HER2-/HoR+ status had more bone metastasis, whereas patients with a HER2+/HoR- status had an increased incidence of liver metastasis. Brain and lung metastasis were more likely to occur in women with a HER2-/HoR- status. The multivariable analysis revealed a significant interaction between single metastasis and molecular subtype. No matter which molecular subtype, women who did not undergo primary tumour surgery had worse survival than those who experienced primary tumour surgery. Collectively, our findings advanced the understanding that molecular subtype might lead to more tailored and effective therapies in metastatic breast cancer patients.

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
(A,B) Overall and breast cancer-specific survival of stage IV patients according to molecular subtype. (C,D) Overall and breast cancer-specific survival of stage IV patients with single metastasis according to site of distant metastasis. (E) Distribution of single metastasis in stage IV patients with different molecular subtypes. P-value of all survival curves was less than 0.001.
Figure 2
Figure 2
(A,B) Overall and breast cancer-specific survival of stage IV patients who received primary tumor surgery or not. P-value of all survival curves was less than 0.001. (C) Forest plot of multivariate analysis for overall survival of stage IV patients with surgery or no surgery using the Cox regression model by adjusting for all other prognostic factors listed. The diamond denotes the HR of each subgroup. An HR > 1.0 indicates higher risk for overall mortality in the no surgery group and vice versa.
Figure 3. Flow diagram for selection of…
Figure 3. Flow diagram for selection of the study cohort.

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