Skip to main content Skip to main navigation menu Skip to site footer

High Bioscore predicts metastasis in breast cancer patients in Sanglah General Hospital, Denpasar, Bali, Indonesia

  • Ika Ariandana ,
  • Ida Bagus Made Suryawisesa ,
  • I Ketut Widiana ,


Background: Risk determination of breast cancer metastases is important for clinicians to be able to estimate the adequate therapy for the patients provide the basis for clinical reasoning and explanation of the possibility of metastasis to breast cancer patients who are in treatment. However, current prediction models have low accuracy and molecular determinants tend to have a high evaluation cost. Bioscore had emerged as a new reliable option in determining the risk of metastases in breast cancer, but it is not widely applied yet. Therefore, it is necessary to study its capability in determining risk of metastasis in the clinical setting in order to validate its future application.

Objective: To determine the bioscore scoring system as a risk determination for metastases in breast cancer at Sanglah Hospital, Denpasar.

Methods: This research was a nested case control study involving 32 subjects in two groups, namely metastatic and non-metastatic breast cancer groups. All patients are registered in the Cancer Registry Data at Sanglah Central General Hospital. The parameters in this study were age, stage, grading, hormonal status, HER2 status, menopausal status, metastatic status and bioscore values. Data were tabulated and statistically analyzed using SPSS 25.

Results: From all subjects, the average patient age of 51.50 (±8.491) years, ranging from 31 - 72 years old. The bioscore was significantly associated with all research variables. Risk analysis showed that breast cancer patients with a high bioscore (5-7) has a significantly higher risk of metastasis (OR: 21.00; 95% CI: 5.620 – 78.475) compared to those with low bioscore (1-4).

Conclusion: The bioscore scoring system may have a significant value in predicting metastasis in breast cancer patients. However, its application still needs further and more comprehensive studies to validate its application in breast cancer management.



  1. Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D. & Bray, F. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in Globocan 2012. International journal of cancer 2015; 136: E359-E386.
  2. Coughlin, S. S. & Ekwueme, D. U. Breast Cancer as a Global Health Concern. Cancer epidemiology 2009; 33: 315-318.
  3. Alvarado, R., Yi, M., Le-Petross, H., Gilcrease, M., Mittendorf, E. A., Bedrosian, I., Hwang, R. F., Caudle, A. S., Babiera, G. V. & Akins, J. S. The Role for Sentinel Lymph Node Dissection after Neoadjuvant Chemotherapy in Patients Who Present with Node-Positive Breast Cancer. Annals of surgical oncology 2012; 19: 3177-3184.
  4. Scully, O. J., Bay, B.-H., Yip, G. & Yu, Y. Breast Cancer Metastasis. Cancer Genomics-Proteomics 2012; 9: 311-320.
  5. Abdel-Rahman, O. M-Bioscore: Proposing a New Statistical Model for Prognostic Factors in Metastatic Breast Cancer Patients. J Comp Eff Res 2018; 7: 845-854.
  6. Mittendorf, E. A., Chavez-Macgregor, M., Vila, J., Yi, M., Lichtensztajn, D. Y., Clarke, C. A., Giordano, S. H. & Hunt, K. K. Bioscore: A Staging System for Breast Cancer Patients That Reflects the Prognostic Significance of Underlying Tumor Biology. Ann Surg Oncol 2017; 24: 3502-3509.
  7. Jamnasi, J., Gondhowiardjo, S. A., Djoerban, Z., Siregar, N. C., Poetiray, E. D. & Tunggono, A. P. Faktor Risiko Terjadinya Metastasis Jauh Pada Pasien Kanker Payudara. Radioterapi & Onkologi Indonesia 2016; 7: 55-59.
  8. Gayathre, S. P. & Maniselvi, S. Correlation of Tumor Size and Immunohistochemistry Status with Lung Metastasis in Carcinoma Breast. International Surgery Journal 2018; 5: 1373.
  9. Aversa, C., Rossi, V., Geuna, E., Martinello, R., Milani, A., Redana, S., Valabrega, G., Aglietta, M. & Montemurro, F. Metastatic Breast Cancer Subtypes and Central Nervous System Metastases. Breast 2014; 23: 623-8.
  10. Tonyali, O., Coskun, U., Yuksel, S., Inanc, M., Bal, O., Akman, T., Yazilitas, D., Ulas, A., Kucukoner, M., Aksoy, A., Demirci, U., Uysal, M., Tanriverdi, O., Gunaydin, Y., Sumbul, A. T., Yildiz, R., Karaca, H., Oksuzoglu, B., Ciltas, A., Buyukberber, S., Benekli, M. & Anatolian Society of Medical, O. Risk Factors for Brain Metastasis as a First Site of Disease Recurrence in Patients with Her2 Positive Early Stage Breast Cancer Treated with Adjuvant Trastuzumab. Breast 2016; 25: 22-6.
  11. Giuliano, A. E., Connolly, J. L., Edge, S. B., Mittendorf, E. A., Rugo, H. S., Solin, L. J., Weaver, D. L., Winchester, D. J. & Hortobagyi, G. N. Breast Cancer-Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. CA Cancer J Clin 2017; 67: 290-303.
  12. Hung, M. H., Liu, C. Y., Shiau, C. Y., Hsu, C. Y., Tsai, Y. F., Wang, Y. L., Tai, L. C., King, K. L., Chao, T. C., Chiu, J. H., Su, C. H., Lo, S. S., Tzeng, C. H., Shyr, Y. M. & Tseng, L. M. Effect of Age and Biological Subtype on the Risk and Timing of Brain Metastasis in Breast Cancer Patients. PLoS One 2014; 9: e89389
  13. Foulkes, W. D., Smith, I. E. & Reis-Filho, J. S. Triple-Negative Breast Cancer. N Engl J Med 2010; 363: 1938-48.
  14. Dent, R., Trudeau, M., Pritchard, K. I., Hanna, W. M., Kahn, H. K., Sawka, C. A., Lickley, L. A., Rawlinson, E., Sun, P. & Narod, S. A. Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence. Clin Cancer Res 2007; 13: 4429-34.

How to Cite

Ariandana, I., Suryawisesa, I. B. M., & Widiana, I. K. (2022). High Bioscore predicts metastasis in breast cancer patients in Sanglah General Hospital, Denpasar, Bali, Indonesia. Indonesia Journal of Biomedical Science, 16(1), 19–23.




Search Panel

Ika Ariandana
Google Scholar
IJBS Journal

Ida Bagus Made Suryawisesa
Google Scholar
IJBS Journal

I Ketut Widiana
Google Scholar
IJBS Journal