Bone metastasis pattern in initial metastatic breast cancer: a population-based study

Zhenchong Xiong, Guangzheng Deng, Xinjian Huang, Xing Li, Xinhua Xie, Jin Wang, Zeyu Shuang, Xi Wang, Zhenchong Xiong, Guangzheng Deng, Xinjian Huang, Xing Li, Xinhua Xie, Jin Wang, Zeyu Shuang, Xi Wang

Abstract

Purpose: Bone is one of the most common sites of breast cancer metastasis, and population-based studies of patients with bone metastasis in initial metastatic breast cancer (MBC) are lacking.

Materials and methods: From 2010 to 2013, 245,707 breast cancer patients and 8901 patients diagnosed with initial bone metastasis were identified by Surveillance, Epidemiology, and End Results database of the National Cancer Institute. Multivariate logistic and Cox regression were used to identify predictive factors for the presence of bone metastasis and prognosis factors. Kaplan-Meier method and log-rank test were used for survival analysis.

Results: Eight thousand nine hundred one patients with initial MBC had bone involvement, accounting for 3.6% of the entire cohort and 62.5% of the patients with initial MBC. Also, 70.5% of patients with bone metastasis were hormone receptor (HR) positive (HR+/human epidermal growth factor receptor 2 [HER2]-: 57.6%; HR+/HER2+: 12.9%). Patients with initial bone metastasis had a better 5-year survival rate compared to those with initial brain, liver, or lung metastasis. HR+/HER2- and HR+/HER2+ breast cancer had a propensity of bone metastasis in the entire cohort and were correlated with better prognosis in patients with initial bone metastasis. Local surgery had significantly improved overall survival in initial MBC patients with bone metastasis.

Conclusion: Our study has provided population-based estimates of epidemiologic characteristics and prognosis in patients with bone metastasis at the time of breast cancer diagnosis. These findings would lend support to optimal surveillance and treatment of bone metastasis in breast cancer.

Keywords: bone; initial metastatic breast cancer; molecular subtype; survival.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Survival rate based on (A) OS and (B) breast CSS in patients with initial metastatic breast cancer. Abbreviations: CSS, cancer-specific survival; OS, overall survival.
Figure 2
Figure 2
Survival analysis among patients with initial bone metastasis. Notes: (A) Patients were stratified as bone metastasis only and multiple metastasis (bone vs multiple: median survival=37 vs 21 months, P<0.001). (B) Patients were stratified as HR+/HER2− (median survival=33 months), HR+/HER2+ (median survival=41 months), HR−/HER2+ (median survival=27 months), TNBC (median survival=10 months), and unknown (median survival=18 months) (P<0.001). (C) Patients were stratified according to whether they underwent local surgery or not (surgery vs no surgery: median survival=43 vs 25 months, P<0.001). Abbreviations: HER2, human epidermal growth factor receptor 2; HR, hormone receptor; TNBC, triple-negative breast cancer.

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Source: PubMed

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