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Purpose <p>Breast cancer molecular subtypes significantly influence metastatic behavior and survival outcomes. However, data on subtype-specific patterns of distant metastasis and prognosis in Middle Eastern populations remain scarce. This study addresses this gap by analyzing a large cohort from southern Iran to better characterize these differences and aid personalized treatment.</p> Methods <p>In this study, 8,491 women with breast cancer from the Shiraz Breast Cancer Registry were analyzed. Patients had known molecular subtypes based on estrogen receptor, progesterone receptor, and HER2 status, and no distant metastases at diagnosis. Patients were followed up until December 30, 2024. Kaplan–Meier, restricted mean survival time and Cox proportional hazards models assessed overall survival (OS) and distant metastasis-free survival (DMFS). (SPSSv27.0 &amp; R package <i>RMST2</i>)</p> Results <p>Luminal A (58.7%) was the most common subtype, followed by Luminal B (18.0%), Triple-Negative (12.7%), and HER2-enriched (10.6%). Among 1,304 patients who developed metastases, Luminal subtypes predominantly showed bone metastasis, whereas Triple-Negative and HER2-enriched tumors favored lung metastasis. Five-year OS differed significantly (<i>p</i> = 0.002), highest in Luminal A (85.1%) and lowest in HER2-enriched (74.2%). Cox regression revealed increased mortality risks for HER2-enriched (HR = 1.83), Triple-Negative (HR = 1.78), and Luminal B (HR = 1.24) compared to Luminal A. DMFS also favored Luminal A.</p> Conclusion <p>This study fills an important regional research gap by demonstrating distinct distant metastasis patterns and survival outcomes across breast cancer molecular subtypes in southern Iran. Luminal A patients have the best prognosis, while HER2-enriched and Triple-Negative subtypes are more aggressive. These findings reinforce the prognostic and therapeutic value of subtype classification in guiding personalized breast cancer management.</p>

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Metastatic patterns and survival outcomes across molecular subtypes in a large cohort of breast cancer patients from the Shiraz breast cancer registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月18日

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  • Majid Akrami,
  • Raha Shahrokhi,
  • Sina Masoumi,
  • Amirhesam Moosazadeh,
  • Nastaran Tavakolian,
  • Zahra keumarsi,
  • Masoumeh Ghoddusi Johari,
  • Vahid Zangouri

摘要

Purpose

Breast cancer molecular subtypes significantly influence metastatic behavior and survival outcomes. However, data on subtype-specific patterns of distant metastasis and prognosis in Middle Eastern populations remain scarce. This study addresses this gap by analyzing a large cohort from southern Iran to better characterize these differences and aid personalized treatment.

Methods

In this study, 8,491 women with breast cancer from the Shiraz Breast Cancer Registry were analyzed. Patients had known molecular subtypes based on estrogen receptor, progesterone receptor, and HER2 status, and no distant metastases at diagnosis. Patients were followed up until December 30, 2024. Kaplan–Meier, restricted mean survival time and Cox proportional hazards models assessed overall survival (OS) and distant metastasis-free survival (DMFS). (SPSSv27.0 & R package RMST2)

Results

Luminal A (58.7%) was the most common subtype, followed by Luminal B (18.0%), Triple-Negative (12.7%), and HER2-enriched (10.6%). Among 1,304 patients who developed metastases, Luminal subtypes predominantly showed bone metastasis, whereas Triple-Negative and HER2-enriched tumors favored lung metastasis. Five-year OS differed significantly (p = 0.002), highest in Luminal A (85.1%) and lowest in HER2-enriched (74.2%). Cox regression revealed increased mortality risks for HER2-enriched (HR = 1.83), Triple-Negative (HR = 1.78), and Luminal B (HR = 1.24) compared to Luminal A. DMFS also favored Luminal A.

Conclusion

This study fills an important regional research gap by demonstrating distinct distant metastasis patterns and survival outcomes across breast cancer molecular subtypes in southern Iran. Luminal A patients have the best prognosis, while HER2-enriched and Triple-Negative subtypes are more aggressive. These findings reinforce the prognostic and therapeutic value of subtype classification in guiding personalized breast cancer management.