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. 2023 Jun;199(2):355-361.
doi: 10.1007/s10549-023-06923-1. Epub 2023 Mar 28.

Metaplastic carcinoma of the breast: matched cohort analysis of recurrence and survival

Priyanka Narayan  1 , Caroline E Kostrzewa  2 , Zhigang Zhang  2 , Diana A Roth O'Brien  3 , Boris A Mueller  3 , John J Cuaron  3 , Amy J Xu  3 , Michael B Bernstein  3 , Beryl McCormick  3 , Simon N Powell  3 , Atif J Khan  3 , Hannah Y Wen  4 , Lior Z Braunstein  5
Affiliations

Metaplastic carcinoma of the breast: matched cohort analysis of recurrence and survival

Priyanka Narayan et al. Breast Cancer Res Treat. 2023 Jun.

Abstract

Purpose: Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer, defined as mammary carcinoma with squamous or mesenchymal differentiation, that may include spindle cell, chondroid, osseous, or rhabdomyoid differentiation patterns. The implications of MBC recurrence and survival outcomes remains unclear.

Methods: Cases were ascertained from a prospectively maintained institutional database of patients treated from 1998 to 2015. Patients with MBC were matched 1:1 to non-MBC cases. Cox proportional-hazards models and Kaplan-Meier estimates were used to evaluate outcome differences between cohorts.

Results: 111 patients with MBC were matched 1:1 with non-MBC patients from an initial set of 2400 patients. Median follow-up time was 8 years. Most patients with MBC received chemotherapy (88%) and radiotherapy (71%). On univariate competing risk regression, MBC was not associated with locoregional recurrence (HR = 1.08; p = 0.8), distant recurrence (HR = 1.65; p = 0.092); disease-free survival (HR = 1.52; p = 0.065), or overall survival (HR = 1.56; p = 0.1). Absolute differences were noted in 8-year disease-free survival (49.6% MBC vs 66.4% non-MBC) and overall survival (61.3% MBC vs 74.4% non-MBC), though neither of these reached statistical significance (p = 0.07 and 0.11, respectively).

Conclusion: Appropriately-treated MBC may exhibit recurrence and survival outcomes that are difficult to distinguish from those of non-MBC. While prior studies suggest that MBC has a worse natural history than non-MBC triple-negative breast cancer, prudent use of chemotherapy and radiotherapy may narrow these differences, although studies with more power will be required to inform clinical management. Longer follow-up among larger populations may further elucidate the clinical and therapeutic implications of MBC.

Keywords: Breast cancer; Breast cancer recurrence; Breast conservation; Chemotherapy; Mastectomy; Metaplastic carcinoma; Radiotherapy.

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Conflict of interest statement

Competing interests: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Locoregional recurrence by metaplastic status
Fig. 2
Fig. 2
Distant recurrence by metaplastic status
Fig. 3
Fig. 3
Disease free survival by metaplastic status
Fig. 4
Fig. 4
Overall survival by metaplastic status
See this image and copyright information in PMC

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