Clinicopathological features of metastatic breast cancer in patients with metabolic syndrome

Abstract

Breast cancer (BC) is a heterogeneous pathology, characterized by clinicopathological and molecular biological features, as well as the clinical course of the neoplastic process, which has certain metastatic “preferences”. The development of metabolic disorders in menopausal women is not only a risk factor for BC but also has a direct impact on the tumor growth, intensity, and topology of distant metastases.

Aim - to identify the clinicopathological features of primary metastatic BC (pMBCa) associated with distant metastasis, based on the hormonal receptor status of tumors in presence of metabolic syndrome (MetS).

Materials and methods. The retrospective study was conducted using the medical records of 88 pMBCa at stage IV who were treated at the National Cancer Institute during 2016-2023. The total number of metastatic lesions was 182, which were further divided into groups, depending on the presence of MetS signs in patients: MetS+ (78 cases) and MetS- (104 cases).  The International Diabetes Federation guidelines (2005) were used to establish the diagnosis of MetS in patients with pMBCa. The study examined the topology of distant metastases, clinical characteristics of patients with pMBCa, taking into account the receptor status of tumors and distribution by morphological structure. The conventional clinical, morphological, immunohistochemical methods, methods of medical and mathematical statistics were used.

Results. In the MetS+ group of patients, metastatic lung involvement was diagnosed the most frequently (43.6% of cases), whereas in the MetS- group of patients, the most common site of distant metastases was the bones (44.2% of cases). In the MetS+ patients, smaller receptor-positive tumors predominantly metastasized to the lungs and liver, while receptor-negative tumors of similar size primarily affected the lungs. It was found, that the presence of MetS signs in patients with pMBCa is associated with a high incidence of metastatic spread to distant organs in the presence of fewer regional lymph nodes. An increase in the number of poorly differentiated tumors was recorded in patients of the MetS+ group with receptor-positive pMBCa cases with distant metastases to the bones and lungs.

Conclusions. The pMBCa in the MetS+ group of patients are associated with the presence of smaller tumors and fewer lymph node involvements, lobular structure, which probably indicates an aggressive course of the malignant process.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. Informed concent of the women was obtained for the research.

The authors declare no conflict of interest.