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Background <p>Breast cancer incidence is increasing worldwide, leading to a growing population of survivors and raising questions about optimal surveillance strategies. Current guidelines do not recommend routine imaging for asymptomatic breast cancer survivors, yet advances in diagnostic technologies may enable earlier detection of distant metastases and potentially improve outcomes. The aim of this study was to evaluate the association between symptom status at the time of distant metastasis detection and post-metastasis overall survival in breast cancer patients.</p> Methods <p>We retrospectively reviewed 7,840 women who underwent surgery for primary breast cancer at Samsung Medical Center between 2010 and 2014 and identified 316 patients who subsequently developed distant metastases. Patients were classified as asymptomatic (<i>n</i> = 204, 64.6%) if metastases were detected during routine follow-up without symptoms, or symptomatic (<i>n</i> = 112, 35.4%) if metastases were diagnosed after symptom onset. Post-metastasis overall survival (PMOS) was evaluated using Kaplan-Meier analysis and Cox proportional hazards models according to symptom status, metastatic burden, and breast cancer subtype.</p> Results <p>Patients whose metastases were detected while asymptomatic had significantly better PMOS than those diagnosed after symptom onset (<i>p</i> &lt; 0.001). Patients with bone-only metastasis showed more favorable survival than those with multi-organ metastases, indicating that lower tumor burden at the time of diagnosis is associated with better prognosis. In subtype-specific analyses, the survival advantage of asymptomatic detection was confined to hormone receptor (HR)-positive disease (<i>p</i> &lt; 0.001), whereas no clear difference was observed among HER2-positive patients.</p> Conclusion <p>Asymptomatic detection of distant metastases, particularly in HR-positive breast cancer, is associated with improved survival and appears to be linked to lower metastatic burden at diagnosis. These findings highlight the potential relevance of symptom status and tumor characteristics in post-metastatic outcomes.</p>

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Association between asymptomatic detection of distant metastases and survival in breast cancer: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月6日

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  • Su Min Lee,
  • Sung Mi Jung,
  • Jai Min Ryu,
  • Byung Joo Chae,
  • Jonghan Yu,
  • Jeong Eon Lee,
  • Seok Won Kim,
  • Seok Jin Nam,
  • Se Kyung Lee

摘要

Background

Breast cancer incidence is increasing worldwide, leading to a growing population of survivors and raising questions about optimal surveillance strategies. Current guidelines do not recommend routine imaging for asymptomatic breast cancer survivors, yet advances in diagnostic technologies may enable earlier detection of distant metastases and potentially improve outcomes. The aim of this study was to evaluate the association between symptom status at the time of distant metastasis detection and post-metastasis overall survival in breast cancer patients.

Methods

We retrospectively reviewed 7,840 women who underwent surgery for primary breast cancer at Samsung Medical Center between 2010 and 2014 and identified 316 patients who subsequently developed distant metastases. Patients were classified as asymptomatic (n = 204, 64.6%) if metastases were detected during routine follow-up without symptoms, or symptomatic (n = 112, 35.4%) if metastases were diagnosed after symptom onset. Post-metastasis overall survival (PMOS) was evaluated using Kaplan-Meier analysis and Cox proportional hazards models according to symptom status, metastatic burden, and breast cancer subtype.

Results

Patients whose metastases were detected while asymptomatic had significantly better PMOS than those diagnosed after symptom onset (p < 0.001). Patients with bone-only metastasis showed more favorable survival than those with multi-organ metastases, indicating that lower tumor burden at the time of diagnosis is associated with better prognosis. In subtype-specific analyses, the survival advantage of asymptomatic detection was confined to hormone receptor (HR)-positive disease (p < 0.001), whereas no clear difference was observed among HER2-positive patients.

Conclusion

Asymptomatic detection of distant metastases, particularly in HR-positive breast cancer, is associated with improved survival and appears to be linked to lower metastatic burden at diagnosis. These findings highlight the potential relevance of symptom status and tumor characteristics in post-metastatic outcomes.