Bone Metastasis Prognostic Factors in Breast Cancer

Akram Yazdani; Sara Dorri; Alirezza Atashi; Hoda Shirafkan; Hedieh Zabolinezhad

doi:10.1177/1178223419830978

Bone Metastasis Prognostic Factors in Breast Cancer

Breast Cancer (Auckl). 2019 Feb 22:13:1178223419830978. doi: 10.1177/1178223419830978. eCollection 2019.

Authors

Akram Yazdani¹, Sara Dorri², Alirezza Atashi³, Hoda Shirafkan¹, Hedieh Zabolinezhad⁴

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
² Medical Informatics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
³ E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Information Technology Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Objective: Bone is the most common site of metastasis in breast cancer. Prognostic factors for predicting bone metastases in breast cancer are controversial yet. In this study, we investigated clinical factors associated with secondary bone metastasis of breast cancer.

Methods: In total, 1690 patients with breast cancer recorded between 2002 and 2012 in Motamed Cancer Institute, Tehran, Iran entered in the retrospective study. We studied age, menopausal status, histologic type, tumor size, number of cancerous axillary lymph nodes, serum concentrations of alkaline phosphatase (ALP), carcinogenicity antigen (CEA), cancer antigen (CA)-153, and hemoglobin (HB) in 2 groups with bone metastases (n = 123) and without it, respectively. We applied logistic regression to identify bone metastasis prognostic factors in breast cancer patients and calculated the cut-off value, sensitivity, and characteristics of independent prognostic factors using receiver operating characteristic (ROC) curve analysis.

Results: Menopause, larger tumor size, and the greater number of cancerous axillary lymph nodes increased the chance of bone metastases significantly (P < .05). There was no significant difference between mean groups with and without bone metastases regarding serum concentration of CEA, CA-153, HB, and histopathologic type (P > .05). Logistic regression showed that age (odds ratio (OR) = 1.021), menopausal status (OR = 1.854), number of cancerous axillary lymph nodes (OR = 1.065), a tumor size between 2 and 5 cm diameter (OR = 2.002) and more than 5 cm diameter (OR = 4.009), and ALP (OR = 1.005) are independent prognostic factors associated with bone metastases. The ROC curve showed that the abovementioned factors have comparable predictive accuracy for bone metastases.

Conclusions: Age, menopausal status, number of axillary lymph node metastases, tumor size, and ALP were identified as prognostic factors for bone metastasis in patients with breast cancer. So patients with these characteristics should be monitored more precisely with regular follow-ups.

Keywords: bone metastases; breast cancer; prognostic factor.