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. 2018 Jan;24(1):41-50.
doi: 10.1111/tbj.12830. Epub 2017 Jun 8.

The role of skin ulceration in breast carcinoma staging and outcome

Thaer Khoury  1 , Carmelo Gaudioso  1 , Yisheng V Fang  2 , Souzan Sanati  3 , Mateusz Opyrchal  4 , Mohamed M Desouki  5 , Rouzan G Karabakhtsian  6 , Zaibo Li  7 , Dan Wang  8 , Li Yan  8 , Rebecca Jacobson  9
Affiliations

The role of skin ulceration in breast carcinoma staging and outcome

Thaer Khoury et al. Breast J. 2018 Jan.

Abstract

Breast carcinoma with skin ulceration (SU) is considered a locally advanced disease. The purpose of the study is to investigate if SU is an independent adverse factor. Breast carcinoma patients with SU (n=111) were included in the study. A subset (n=38, study cohort) was matched with cases that had no SU (n=38, matched cohort); the survival analyses were compared between these groups. Then, cases (n=80) were staged independent from SU into stage I, II or III. Disease free survival (DFS) and overall survival (OS) were analyzed. Patients with larger tumors tended to present with distant metastases more often than patients with smaller tumors (P=.004). In the matched cases, the 5-year DFS probability was 53% for the study cohort and 58% for the matched cohort; and for OS 75% for the study cohort and 84% for the matched cohort with no statistical significant difference. However, there was a trend towards worse DFS for the patients whose tumors had SU. When the cases were staged based on tumor size and node status (I, II or III), the OS was statistically significant (P=.047) but not the DFS (P=.195). Relatively small tumors with SU had an extent of disease similar to that observed in patients with early stages disease. The survival analysis suggests that SU may not be an adverse factor. However, more cases are needed to further examine this finding.

Keywords: breast carcinoma; skin ulceration; staging; survival.

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Figures

Figure 1
Figure 1
Survival curves for study and matched cohorts; A, OS and B, DFS.
Figure 2
Figure 2
Survival curves based on tumor size (T1, T2, T3) including stage-IV cases (A and B) and excluding stage-IV (C and D); A, OS including stage-IV; B, DFS including stage-IV; C, OS excluding stage-IV; and D, DFS excluding stage-IV.
Figure 3
Figure 3
Survival curves based on tumor stage (stage I, II and III); A, OS and B, DFS.
Figure 4
Figure 4
Barplot of 5 year survival by size of tumor and number of positive lymph nodes.
Figure 5
Figure 5
Survival curves based on tumor stage considering all cases as pT4b; A, OS and B, DFS.
Figure 6
Figure 6
Survival curves; A, OS based on age; B, OS based on Anti-HER2 therapy; C, DFS based on tumor focality (multifocal vs. unifocal); D, DFS based on margin status (positive vs. negative); E, DFS based on lymph node status (negative vs. at least one positive); F, OS based on best tumor size cutoff (1.7-cm)
See this image and copyright information in PMC

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