{"id":"https://openalex.org/W7225253994","doi":"https://doi.org/10.1007/s00432-026-06631-5","title":"Determinants of synchronous and metachronous metastatic breast cancer (2000\u20132024)\u2013an analysis based on data from German cancer registries","display_name":"Determinants of synchronous and metachronous metastatic breast cancer (2000\u20132024)\u2013an analysis based on data from German cancer registries","publication_year":2026,"publication_date":"2026-11-04","ids":{"openalex":"https://openalex.org/W7225253994","doi":"https://doi.org/10.1007/s00432-026-06631-5"},"language":"en","primary_location":{"id":"doi:10.1007/s00432-026-06631-5","doi":"https://doi.org/10.1007/s00432-026-06631-5","is_oa":true,"landing_page_url":"https://doi.org/10.1007/s00432-026-06631-5","pdf_url":null,"source":{"id":"https://openalex.org/S10075937","display_name":"Journal of Cancer Research and Clinical Oncology","issn_l":"0084-5353","issn":["0084-5353","0171-5216","0301-1585","1432-1335"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Cancer Research and Clinical Oncology","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1007/s00432-026-06631-5","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5068968693","display_name":"Mar\u00eda Elena Lacruz","orcid":"https://orcid.org/0000-0003-2036-3039","observed_orcids":["https://orcid.org/0000-0003-2036-3039"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"M. E. Lacruz","raw_affiliation_strings":["Cancer Registry Saxony-Anhalt, Magdeburg, Germany"],"raw_orcid":"https://orcid.org/0000-0003-2036-3039","affiliations":[{"raw_affiliation_string":"Cancer Registry Saxony-Anhalt, Magdeburg, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5027674028","display_name":"A. Bedir","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"A. Bedir","raw_affiliation_strings":["Cancer Registry Saxony-Anhalt, Magdeburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Cancer Registry Saxony-Anhalt, Magdeburg, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160588926","display_name":"I. Wittenberg","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"I. Wittenberg","raw_affiliation_strings":["Cancer Registry Saxony-Anhalt, Magdeburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Cancer Registry Saxony-Anhalt, Magdeburg, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160721223","display_name":"S. Thies","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"S. Thies","raw_affiliation_strings":["Cancer Registry Saxony-Anhalt, Magdeburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Cancer Registry Saxony-Anhalt, Magdeburg, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160579751","display_name":"C. Schneider","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"C. Schneider","raw_affiliation_strings":["Clinical-Epidemiological Cancer Registry Brandenburg-Berlin, Cottbus, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Clinical-Epidemiological Cancer Registry Brandenburg-Berlin, Cottbus, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160577307","display_name":"F. Reinwald","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"F. Reinwald","raw_affiliation_strings":["Cancer Registry of Rhineland-Palatinate in the Institute for Digital Health Data, Mainz, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Cancer Registry of Rhineland-Palatinate in the Institute for Digital Health Data, Mainz, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160694118","display_name":"W. Hoffmann","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2799318839","display_name":"Universit\u00e4tsmedizin Greifswald","ror":"https://ror.org/025vngs54","country_code":"DE","type":"healthcare","lineage":["https://openalex.org/I2799318839"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"W. Hoffmann","raw_affiliation_strings":["Cancer Registry Mecklenburg-Western Pomerania, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Cancer Registry Mecklenburg-Western Pomerania, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany","institution_ids":["https://openalex.org/I2799318839"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5015149331","display_name":"Simone Fai\u00dft","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"S. Fai\u00dft","raw_affiliation_strings":["Institute for Health Services Research at the Oncology Center Stuttgart E.V., Stuttgart, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Institute for Health Services Research at the Oncology Center Stuttgart E.V., Stuttgart, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160605084","display_name":"B. Franke","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"B. Franke","raw_affiliation_strings":["Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160576665","display_name":"K. Kleihues","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"K. Kleihues","raw_affiliation_strings":["Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160717240","display_name":"S. R. Zeissig","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I25974101","display_name":"University of W\u00fcrzburg","ror":"https://ror.org/00fbnyb24","country_code":"DE","type":"education","lineage":["https://openalex.org/I25974101"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"S. R. Zeissig","raw_affiliation_strings":["Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany","Bavarian Cancer Registry-Regional Center W\u00fcrzburg, Bavarian Health and Food Safety Authority, W\u00fcrzburg, Germany","Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of W\u00fcrzburg, W\u00fcrzburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Association of German Tumor Centers (ADT), Network for Care, Quality and Research in Oncology, Berlin, Germany","institution_ids":[]},{"raw_affiliation_string":"Bavarian Cancer Registry-Regional Center W\u00fcrzburg, Bavarian Health and Food Safety Authority, W\u00fcrzburg, Germany","institution_ids":[]},{"raw_affiliation_string":"Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of W\u00fcrzburg, W\u00fcrzburg, Germany","institution_ids":["https://openalex.org/I25974101"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160640812","display_name":"M. Klinkhammer-Schalke","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I60668342","display_name":"University of Regensburg","ror":"https://ror.org/01eezs655","country_code":"DE","type":"education","lineage":["https://openalex.org/I60668342"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"M. Klinkhammer-Schalke","raw_affiliation_strings":["Tumor Center Regensburg, Center for Quality Management and Health Care Research of the University, Regensburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Tumor Center Regensburg, Center for Quality Management and Health Care Research of the University, Regensburg, Germany","institution_ids":["https://openalex.org/I60668342"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5126227723","display_name":"M. Gerken","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I60668342","display_name":"University of Regensburg","ror":"https://ror.org/01eezs655","country_code":"DE","type":"education","lineage":["https://openalex.org/I60668342"]}],"countries":["DE"],"is_corresponding":false,"raw_author_name":"M. Gerken","raw_affiliation_strings":["Tumor Center Regensburg, Center for Quality Management and Health Care Research of the University, Regensburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Tumor Center Regensburg, Center for Quality Management and Health Care Research of the University, Regensburg, Germany","institution_ids":["https://openalex.org/I60668342"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160714537","display_name":"E. C. Sturm-Inwald","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210097296","display_name":"Health and Safety Authority","ror":"https://ror.org/00sx2c320","country_code":"IE","type":"healthcare","lineage":["https://openalex.org/I4210097296"]},{"id":"https://openalex.org/I60668342","display_name":"University of Regensburg","ror":"https://ror.org/01eezs655","country_code":"DE","type":"education","lineage":["https://openalex.org/I60668342"]}],"countries":["DE","IE"],"is_corresponding":false,"raw_author_name":"E. C. Sturm-Inwald","raw_affiliation_strings":["Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Regensburg, Germany","Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Regensburg, Germany","institution_ids":["https://openalex.org/I4210097296"]},{"raw_affiliation_string":"Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany","institution_ids":["https://openalex.org/I60668342"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5050289740","display_name":"Atanas Ignatov","orcid":"https://orcid.org/0000-0002-9006-4029","observed_orcids":["https://orcid.org/0000-0002-9006-4029"]},"institutions":[{"id":"https://openalex.org/I95793202","display_name":"Otto-von-Guericke-Universit\u00e4t Magdeburg","ror":"https://ror.org/00ggpsq73","country_code":"DE","type":"education","lineage":["https://openalex.org/I95793202"]}],"countries":["DE"],"is_corresponding":true,"raw_author_name":"A. Ignatov","raw_affiliation_strings":["University Hospital for Obstetrics and Gynecology, Medical Faculty, Otto-Von-Guericke University, Magdeburg, Germany"],"raw_orcid":"https://orcid.org/0000-0002-9006-4029","affiliations":[{"raw_affiliation_string":"University Hospital for Obstetrics and Gynecology, Medical Faculty, Otto-Von-Guericke University, Magdeburg, Germany","institution_ids":["https://openalex.org/I95793202"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5050289740","https://openalex.org/A5068968693"],"corresponding_institution_ids":["https://openalex.org/I95793202"],"apc_list":{"value":4390,"currency":"USD","value_usd":4390},"apc_paid":{"value":4390,"currency":"USD","value_usd":4390},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.82232393,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"152","issue":"11","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10183","display_name":"Breast Cancer Treatment Studies","score":0.9976000189781189,"subfield":{"id":"https://openalex.org/subfields/1306","display_name":"Cancer Research"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},"topics":[{"id":"https://openalex.org/T10183","display_name":"Breast Cancer Treatment Studies","score":0.9976000189781189,"subfield":{"id":"https://openalex.org/subfields/1306","display_name":"Cancer Research"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T11134","display_name":"Breast Lesions and Carcinomas","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2734","display_name":"Pathology and Forensic Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12992","display_name":"Metastasis and carcinoma case studies","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8707000017166138},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.7253000140190125},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.715399980545044},{"id":"https://openalex.org/C2775930923","wikidata":"https://www.wikidata.org/wiki/Q12859063","display_name":"Metastatic breast cancer","level":4,"score":0.6629999876022339},{"id":"https://openalex.org/C2779013556","wikidata":"https://www.wikidata.org/wiki/Q181876","display_name":"Metastasis","level":3,"score":0.5680999755859375},{"id":"https://openalex.org/C530470458","wikidata":"https://www.wikidata.org/wiki/Q128581","display_name":"Breast cancer","level":3,"score":0.5436999797821045},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.5436000227928162},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.5401999950408936},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.5259000062942505},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.5210999846458435},{"id":"https://openalex.org/C194409129","wikidata":"https://www.wikidata.org/wiki/Q103824","display_name":"Hematology","level":2,"score":0.5087000131607056},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.4081000089645386},{"id":"https://openalex.org/C118646709","wikidata":"https://www.wikidata.org/wiki/Q1657620","display_name":"CA15-3","level":4,"score":0.3154999911785126},{"id":"https://openalex.org/C146304588","wikidata":"https://www.wikidata.org/wiki/Q961652","display_name":"Case-control study","level":2,"score":0.30070000886917114},{"id":"https://openalex.org/C2777783956","wikidata":"https://www.wikidata.org/wiki/Q848085","display_name":"Bone metastasis","level":4,"score":0.29499998688697815},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.28949999809265137},{"id":"https://openalex.org/C2778527826","wikidata":"https://www.wikidata.org/wiki/Q1787017","display_name":"Cancer registry","level":3,"score":0.27489998936653137},{"id":"https://openalex.org/C88879693","wikidata":"https://www.wikidata.org/wiki/Q217690","display_name":"Cumulative incidence","level":3,"score":0.273499995470047},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.2563999891281128}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1007/s00432-026-06631-5","doi":"https://doi.org/10.1007/s00432-026-06631-5","is_oa":true,"landing_page_url":"https://doi.org/10.1007/s00432-026-06631-5","pdf_url":null,"source":{"id":"https://openalex.org/S10075937","display_name":"Journal of Cancer Research and Clinical Oncology","issn_l":"0084-5353","issn":["0084-5353","0171-5216","0301-1585","1432-1335"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Cancer Research and Clinical Oncology","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1007/s00432-026-06631-5","doi":"https://doi.org/10.1007/s00432-026-06631-5","is_oa":true,"landing_page_url":"https://doi.org/10.1007/s00432-026-06631-5","pdf_url":null,"source":{"id":"https://openalex.org/S10075937","display_name":"Journal of Cancer Research and Clinical Oncology","issn_l":"0084-5353","issn":["0084-5353","0171-5216","0301-1585","1432-1335"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Cancer Research and Clinical Oncology","raw_type":"journal-article"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":22,"referenced_works":["https://openalex.org/W1993497779","https://openalex.org/W2021395262","https://openalex.org/W2098775844","https://openalex.org/W2103938232","https://openalex.org/W2116760308","https://openalex.org/W2170602872","https://openalex.org/W2266814182","https://openalex.org/W2318605753","https://openalex.org/W2765703634","https://openalex.org/W2767600184","https://openalex.org/W2806699208","https://openalex.org/W2899471886","https://openalex.org/W3031826692","https://openalex.org/W3107885361","https://openalex.org/W3128646645","https://openalex.org/W3165434707","https://openalex.org/W4210816098","https://openalex.org/W4312020008","https://openalex.org/W4385490660","https://openalex.org/W4391942159","https://openalex.org/W7160912527","https://openalex.org/W7160963844"],"related_works":[],"abstract_inverted_index":{"Abstract":[0],"Purpose":[1],"To":[2],"investigate":[3],"the":[4,12,116,148,221,241],"association":[5],"of":[6,17,57,119,151,225,244],"molecular":[7],"breast":[8,37,227],"cancer":[9,28,38],"subtypes":[10,99,219],"with":[11,35,64,102,110,186,197,233],"timing":[13,222],"and":[14,42,89,105,181,204,211,223,253],"organ-specific":[15,90],"patterns":[16,92,193],"metastatic":[18,91,107,226,235],"disease.":[19,108],"Methods":[20],"We":[21],"analyzed":[22,83],"data":[23],"from":[24],"nine":[25],"German":[26],"regional":[27],"registries,":[29],"including":[30],"172":[31],"512":[32],"women":[33],"diagnosed":[34],"invasive":[36],"between":[39,179],"January":[40],"2000":[41],"March":[43],"2024.":[44],"Patients":[45],"were":[46,67,93,100],"classified":[47],"as":[48],"having":[49],"no":[50,134],"metastases,":[51,203],"synchronous":[52,65,104,120,234],"metastases":[53,66,153],"(within":[54],"three":[55],"months":[56],"diagnosis),":[58],"or":[59],"metachronous":[60,80,106,152,245],"metastases.":[61],"Factors":[62],"associated":[63,101,232],"assessed":[68],"using":[69,84],"multivariable":[70,85],"binary":[71],"logistic":[72],"regression":[73],"adjusted":[74],"for":[75],"confounders.":[76],"Time":[77],"to":[78],"first":[79],"metastasis":[81,121],"was":[82],"Cox":[86],"regression.":[87],"Timing":[88],"compared":[94],"across":[95],"subtypes.":[96],"Results":[97],"Molecular":[98,218],"both":[103],"Compared":[109],"HR+/HER2\u2212":[111,170,198],"tumors,":[112],"HR\u2212/HER2+":[113],"tumors":[114,132,146,164,171,199,206,230,239],"had":[115,147],"highest":[117,149,242],"odds":[118,136],"(adjusted":[122,154],"OR":[123],"[aOR]":[124],"1.69,":[125],"95%CI":[126,139,158,174],"1.57":[127],"\u2013":[128,141,160],"1.83),":[129],"whereas":[130,237],"HR\u2212/HER2\u2212":[131,145,205,238],"showed":[133,165,240],"increased":[135,178],"(aOR":[137],"0.96,":[138],"0.90":[140],"1.02).":[142],"In":[143],"contrast,":[144],"risk":[150,168,188,243,251],"HR":[155],"[aHR]":[156],"1.48,":[157],"1.41":[159],"1.55),":[161],"while":[162],"HR+/HER2+":[163],"a":[166],"lower":[167],"than":[169],"(aHR":[172],"0.88,":[173],"0.84\u20130.93).":[175],"Cumulative":[176],"incidence":[177],"5":[180],"10":[182],"years":[183],"after":[184],"diagnosis,":[185],"late":[187],"among":[189],"HR-positive":[190],"tumors.":[191],"Metastatic":[192],"differed":[194],"by":[195],"subtype,":[196],"showing":[200],"predominantly":[201],"bone":[202],"exhibiting":[207],"more":[208],"frequent":[209],"visceral":[210],"central":[212],"nervous":[213],"system":[214],"(CNS)":[215],"involvement.":[216],"Conclusion":[217],"influence":[220],"distribution":[224],"cancer.":[228],"HER2-positive":[229],"are":[231],"presentation,":[236],"metastasis.":[246],"These":[247],"findings":[248],"support":[249],"subtype-specific":[250],"assessment":[252],"surveillance":[254],"strategies.":[255]},"counts_by_year":[],"updated_date":"2026-11-05T12:25:35.769452","created_date":"2026-11-05T00:00:00"}
