Risk factors for initial lung metastasis from breast invasive ductal carcinoma in stages I-III of operable patients.

The aim of this study was to evaluate high-risk factors for initial lung metastases from breast invasive ductal carcinomas in operable patients with Stages I-III invasive ductal carcinoma. Data of all patients who underwent radical mastectomy were reviewed retrospectively, and they were confirmed with invasive ductal breast cancer between January 2003 and December 2007. Routine clinical examination data of patients included in the study at primary diagnosis, adjuvant modes and first metastasis sites were recorded. Possible risk factors were easily identified from patients. Twenty-eight potential risk factors were investigated. Finally, 78 patients with complete data in the potential factors were found eligible, and univariate and multivariate analyses were conducted. Univariate analyses showed that the status of estrogen receptor (ER) and progesterone receptor (PR) and the status of the epidermal growth factor receptor-2 (Her2) were high-risk factors for invasive ductal breast cancer metastasis to the lung as the first organ. P values were, respectively, 0.045, 0.049 and 0.026. Multivariate analyses showed that the pN3 stage needs to be combined with vascular invasion to predict initial lung metastasis. The status of ER and PR was also viewed in combination with p53 negative to predict lung metastasis. Further analyses demonstrated that a subtype of four negative in breast cancer was significantly associated with initial lung metastasis. Patients with pN3 stage and vascular invasion were more likely to develop lung metastasis. A new subtype with Her2 negative, both ER-negative and PR negative combination with p53 negative, had a great tendency to develop initial lung metastasis in breast invasive ductal cancer patients.