Clinico-pathologic factors associated with the occurrence of early and late metastatic spread in a cohort of breast cancer patients

Article type: Research Article

Authors: Barco, Israel^a; | Chabrera, Carol^b | García-Fernández, Antonio^a | Fraile, Manel^c | Giménez, Nuria^d | Vallejo, Elena^a | Zarco, Patricia^a | González, Sonia^e | González, Clarisa^f | Larrañaga, Itziar^g | Garcia-Font, Marc^h

Affiliations: [a] Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain | [b] Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Barcelona, Spain | [c] Nuclear Medicine Department, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain | [d] Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain | [e] Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain | [f] Department of Pathology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain | [g] Department of Surgery, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain | [h] University International of Catalunya, Barcelona, Spain

Correspondence: [*] Corresponding author: Israel Barco Nebreda, MD, Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain C/Sant Antoni, 21, 08221 Terrassa, Spain. Tel.: +34 93 536 50 85; Fax: +34 93 736 50 86; E-mail: ibarco@mutuaterrassa.es, israbarcone@yahoo.es. ORCIDs: 0000-0003-3520-8736 (Israel Barco); 0000-0002-8236-0952 (Antonio García-Fernández); 0000-0002-0962-6216 (Nuria Giménez)

Abstract: BACKGROUND AND OBJECTIVE:Distant metastatic spread in breast cancer patients is a complex phenomenon involving several prognostic factors. We focused our analysis on early metastatic breast cancer (EMBC) (occurring during the first 36 months) versus late metastatic breast cancer (LMBC) (occurring beyond 3 years) in order to ascertain their possible differential predictive factors. METHODS:diagnostic, surgical, and follow-up data were assessed for consecutive patients with breast cancer undergoing surgery between 1997 and 2019. We analysed the predictive factors for distant metastasis using both univariate and multivariate analysis. RESULTS:The median follow-up for this cohort of 2708 patients was 89 months. The median metastasis-free interval (FMI) for metastasis patients was 38 months (17 months for EMBC group and 76 months for LMBC group). Distant metastases developed in 12.9% (350/2708); 48% (168/350) of them as EMBC and 52% (182/350) as LMBC. Loco-regional recurrence and nodal extracapsular extension were the only common predictors for both. CONCLUSIONS:EMBC and LMBC appeared as two separate conditions, with a different outcome. In the EMBC group, tumour proliferation related factors were significant (histological grade, tumour size, body mass index), whereas for LMBC, other slow-acting factors seemed to be involved (screening program, tumour burden, bilateral tumour).

Keywords: Breast neoplasms, neoplasm metastasis, early detection of cancer, survival, mortality

DOI: 10.3233/BD-210086

Journal: Breast Disease, vol. 41, no. 1, pp. 365-372, 2022