Comparison between de novo and metachronous metastatic breast cancer: the presence of a primary tumour is not the only difference - a Dutch population based study from 2008-2018.

AbstractPurposeThe aim of this study was to compare characteristics and survival of patients withde novoand metachronous metastatic breast cancer.MethodsData of patients with metastatic breast cancer were obtained from the Netherlands Cancer Registry. Patients were categorized as havingde novometastatic breast cancer (n=8,656) if they had distant metastases at initial presentation, or metachronous metastatic disease (n= 2,374) in case they developed metastases within 5 or 10 years after initial breast cancer diagnosis. Clinicopathological characteristics and treatments of these two groups were compared, after which multiple imputation was performed to account for missing data. Overall survival was compared for patients treated with systemic therapy in the metastatic setting, using Kaplan Meier curves and multivariable Cox proportional hazards models. The hazard ratio for overall survival ofde novoversus metachronous metastases was assessed accounting for time-varying effects.ResultsCompared to metachronous patients, patients with denovometastatic breast cancer were more likely to be ≥70 years, to have invasive lobular carcinoma, clinical T3 or T4 tumours, loco-regional lymphnode metastases, HER2 positivity, bone only disease and to have received systemic therapy in the metastatic setting. They were less likely to have triple negative tumours and liver or brain metastases. Patients withde novometastases survived longer (median 34.7 months) than patients with metachronous metastases (median 24.3 months) and the hazard ratio (0.75) varied over time.ConclusionsDifferences in clinicopathological characteristics and survival betweende novoand metachronous metastatic breast cancer highlight that these are distinct patients groups.