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. 2018 Aug;25(8):2249-2260.
doi: 10.1245/s10434-018-6533-3. Epub 2018 May 31.

Metaplastic Breast Cancer Treatment and Outcomes in 2500 Patients: A Retrospective Analysis of a National Oncology Database

Cecilia T Ong  1 , Brittany M Campbell  2 , Samantha M Thomas  3   4 , Rachel A Greenup  1   4 , Jennifer K Plichta  1   4 , Laura H Rosenberger  1   4 , Jeremy Force  4   5 , Allison Hall  4   6 , Terry Hyslop  3   4 , E Shelley Hwang  1   4 , Oluwadamilola M Fayanju  7   8
Affiliations

Metaplastic Breast Cancer Treatment and Outcomes in 2500 Patients: A Retrospective Analysis of a National Oncology Database

Cecilia T Ong et al. Ann Surg Oncol. 2018 Aug.

Abstract

Background: Metaplastic breast cancer (MBC) is characterized by chemoresistance and hematogenous spread. We sought to identify factors associated with improved MBC outcomes and increased likelihood of MBC diagnosis.

Methods: Women ≥ 18 years of age with stage I-III MBC and non-MBC diagnosed between 2010 and 2014 were identified in the National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional hazards models were used to estimate associations with overall survival (OS). Multivariate logistic regression identified factors associated with MBC diagnosis.

Results: Overall, 2451 MBC and 568,057 non-MBC patients were included; 70.3% of MBC vs. 11.3% of non-MBC patients were triple negative (p < 0.001). Five-year OS was reduced among MBC vs. non-MBC patients for the entire cohort (72.7 vs. 87.5%) and among triple-negative patients (71.1 vs. 77.8%; both p < 0.001). In MBC, triple-negative (vs. luminal) subtype was not associated with worse OS (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.88-1.54, p = 0.28). Compared with non-MBC patients, MBC patients were more likely to receive mastectomy (59.0 vs. 44.9%), chemotherapy (74.1 vs. 43.1%), and axillary lymph node dissection (ALND; 35.2 vs. 32.2%, all p ≤ 0.001). MBC patients more frequently had negative ALND (pN0) than non-MBC patients (20.0 vs. 10.6%, p < 0.001). Among MBC patients, chemotherapy (HR 0.69, 95% CI 0.53-0.89, p = 0.004) and radiotherapy (HR 0.52, 95% CI 0.39-0.69, p < 0.001) were associated with improved survival, while ALND was associated with decreased survival (HR 1.37, 95% CI 1.06-1.77, p = 0.02).

Conclusions: MBC patients had worse survival than non-MBC patients, independent of receptor status, suggesting that MBC may confer an additional survival disadvantage. Multimodal therapy was associated with improved outcomes, but ALND was not and may be overutilized in MBC.

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Figures

Figure 1
Figure 1. Parts A–D. Pathologic features of diagnosis of metaplastic breast carcinoma
In metaplastic carcinoma, the mesenchymal component can be markedly atypical (spindle cells in A and B) or bland, resembling fibromatosis (spindle cells in C and D). The epithelial component can have glandular (B, arrow) and/or squamous (arrowheads in B and D) differentiation.
Figure 2
Figure 2
Unadjusted overall survival: TNBC patients only
See this image and copyright information in PMC

Comment in

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