ABSTRACT
Background and purpose:Breast cancer can be divided into several molecular subtypes according to its biomarkers. The pattern of distant metastasis has a great clinic significance but was rarely investigated. This study investigated the impact of molecular subtype of breast cancer on initial sites of metastasis..Methods:All the patients with operable invasive breast cancer diagnosed in Zhongshan People’s Hospital between 1998 and 2004 were recruited. Subtypes were defined as Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER-2) enriched, and triple negative (TN) according to the expression of estrogen receptor (ER), progestogen receptor (PR) and HER-2 status. The first distant metastatic sites and the time of their appearances were recorded. Survival curves were constructed using the Ka-plan-Meier technique.Results:Among 390 eligible patients, there were 215(55.1%) with Luminal A, 43 (11.0%) with Lu-minal B, 52 (13.3%) with HER-2 enriched, and 80 (20.5%) with TN. The median follow-up time was 118 months (11-163 months). Seventy-two (18.5%) distant metastases occurred during follow-up: 37 metastases in Luminal A, 8 in Luminal B, 10 in HER-2, 17 in TN. Bone was the most common site of the first distant metastasis (39/72, 54.2%) followed by lung (25/72, 34.7%), liver (22/72, 30.6%), and brain (7/72, 9.7%). Among all the metastases, tumors of Luminal type (Luminal A 70.2%, Luminal B 50.0%) had a higher chance of bone involvement than that of HER-2 enriched (30.0%) and TN (35.3%,P=0.03). Both Luminal B (37.5%) and TN (17.6%) subtypes had a higher percentage of brain involvement than Luminal A and HER-2 enriched (P=0.01). The survival analysis showed no significant difference among the four subtypes in 9-year distant metastasis-free survival. However, distant metastasis appeared earlier in HER-2 enriched and TN breast cancer than in Luminal type.Conclusion:Organ-specific metastasis may depend on the molecular subtype of breast cancer. Bone metastasis occurs more in luminal type than in other types. Luminal B and TN types of tumors had more chance of brain metastasis than Luminal A and HER-2 enriched type of tumors.
ABSTRACT
Background and purpose:Immunity function is one of the most profound factors in affecting the prognosis of breast cancer patients. Cytotoxic T lymphocytes counts in the peripheral blood and focal tumor tissue could indicate the overall survival time of these patients. On the other hand, adjuvant chemotherapy is also an important part in improving both the disease free survival and overall survival time of breast cancer patients. Selecting chemotherapy regime which is both able to kill all the tumor cells and reserve the immunity function to the greatest extent is of great importance in improving the survival rate of breast cancer patients. The aim of this study was to compare the effect of two chemotherapy regimens CEF (cyclophosphamide, epirubicin and lfuorouracil) and EC followed by P (paclitaxel) on the peripheral blood lymphocytes in early stage breast cancer. Methods:The clinicopathological characteristics and peripheral blood lymphocyte parameters before and after chemotherapy of CEF or EC-P regimen were retrospectively analyzed in post-operate patients with early stage breast cancer during the period from Nov. 2012 to May 2013. The lymphocyte parameters included: total blood lymphocytes count, percentages of T lymphocytes, cytotoxic T lymphocytes, helper T lymphocytes, active T lymphocytes and nature killer (NK) cells. Results: Patients undertook EC-P regimen were those at comparably high risk (signiifcant differences of clinical stage, tumor size, axillary lymph node status, estrogen/progestogen receptor and histological subtype were observed). There was no difference of lymphocyte parameters between these two groups before adjuvant chemotherapy. However, during the process of chemotherapy, peripheral blood lymphocytes counts decreased signiifcantly after 4 and 5 cycles of chemotherapy of CEF regime (1 077±359/μL;1 181±271/μL) compared with the level before chemotherapy (1 607±322/μL, P0.05). Percentage of active T lymphocyte increased signiifcantly along with the chemotherapy in both groups (CEF group:11.8±7.1 vs 23±9.3, P<0.05;EC-P group:11.8±5.8 vs 17.6±8.2, P<0.05) (pre-chemotherapy vs after 5 cycles of chemotherapy). In EC-P group, the percentage of helper T lymphocyte (37.8±5.7) decreased significantly compared with the levels before chemotherapy (41.3±4.3) and before paclitaxel was undertaken (41.9±5.6, P<0.05) and the percentage of NK cells (21.5±5.2) increased significantly compared with the levels before chemotherapy (15.3±7.6) and before paclitaxel was undertaken (14.9±5.9, P<0.01) after one cycle of paclitaxel therapy. Conclusion:The effect of chemotherapy on peripheral blood lymphocyte is less profound in EC-P group compared to CEF group. Furthermore, paclitaxel can increase the NK cells without any effect to the levels of T lymphocytes and cytotoxic T lymphocyte. It is superior over other drug in conserving immune function in early stage breast cancer.