New insights into patterns of first metastatic sites influencing survival of patients with hormone receptor-positive, HER2-negative breast cancer: a multicenter study of 271 patients
Abstract Background: The initial therapeutic strategy for hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer is based on the first metastatic site, but little evidence is available regarding the influence of metastatic distribution patterns of first metastatic sites on prognosis. In this study, we aimed to identify the metastatic distribution patterns of first metastatic sites that significantly correlate with survival after recurrence.Methods: We performed a retrospective review of records from 271 patients with recurrent metastatic HR+/ HER2- breast cancer diagnosed between January 2000 and December 2015. We assessed survival after recurrence according to the metastatic distribution patterns of first metastatic sites and identified significant prognostic factors among the patients with single and multiple metastases.Results: Prognosis was significantly better in patients with single metastasis than those with multiple metastases (median overall survival after recurrence: 5.86 years vs. 2.50 years, p<0.001). No metastatic organ site with single metastasis was significantly associated with prognostic outcome, though single metastasis with diffuse lesions was an independent risk factor for worse prognosis (HR: 3.641; 95% CI: 1.856-7.141), and more easily progressed to multiple metastases (p=0.002). Multiple metastases including liver metastasis (HR: 3.145; 95% CI: 1.802-5.495) or brain metastasis (HR: 3.289; 95% CI: 1.355-7.937) were regarded as a significant independent poor prognostic factor, but multiple metastases not involving liver or brain metastasis were not significantly related to prognosis after recurrence.Conclusions: Single metastasis with diffuse lesions could more easily disseminate systemically and progress to multiple metastases, leading to poor prognosis similar to multiple metastases. Our findings indicate that reconsideration of the determinant factors of therapeutic strategies for first recurrence in HR+/HER2- breast cancer may be needed.