Metaplastic breast cancer: clinicopathological features and its prognosis
- Hyewon Lee1,
- So-Youn Jung2,
- Jae Yun Ro2,
- Youngmee Kwon2,
- Joo Hyuk Sohn3,
- In Hae Park2,
- Keun Seok Lee1,2,
- Seeyoun Lee2,
- Seok Won Kim2,
- Han Sung Kang2,
- Kyoung Lan Ko2,
- Jungsil Ro1,2
- 1Center for Clinical Trials, National Cancer Center, Goyang, Korea
- 2Center for Breast Cancer, National Cancer Center, Goyang, Korea
- 3Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Dr Jungsil Ro, Center for Clinical trials and Center for Breast Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Korea;
Contributors HL drafted the manuscript and performed the statistical analysis. JR conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors participated in the study, read and approved the final manuscript.
- Accepted 8 January 2012
- Published Online First 12 March 2012
Aims The prognosis of metaplastic breast cancer (MBC) is reportedly worse than that of triple-negative invasive ductal carcinoma (TN-IDC), but the determinants of poor prognosis are not yet known.
Methods Patients from two Korean cancer centres were included in this study (67 MBC and 520 TN-IDC). Characteristics of the two disease groups, including clinical parameters, histological features, chemoresponsiveness, disease recurrence and survival estimates, were evaluated.
Results MBC presented with larger tumours, more frequent distant metastasis and higher histological grade compared with TN-IDC (p<0.001). All but nine patients with MBC had triple-negative disease. Disease-free survival and overall survival (OS) of MBC were worse than TN-IDC (p<0.001). Multivariable analysis of disease-free survival revealed MBC type as an independent prognostic factor (HR 2.53; 95% CI 1.32 to 4.84) along with lymph node metastasis and implementation of breast conserving surgery. For OS, MBC type remained a significant prognostic factor (HR 2.56; 95% CI 1.18 to 5.54). Chemoresponsiveness of MBC and TN-IDC were similar in both neoadjuvant (p=1.000) and advanced disease settings (p=0.508). For a given MBC type, risk factors for disease recurrence included the presence of a squamous component (HR 4.0; 95% CI 1.46 to 10.99) and lymph node metastasis (HR 4.76; 95% CI 1.67 to 13.60); the risk factor for OS was initial distant metastasis (HR 10.77; 95% CI 2.59 to 44.76).
Conclusions MBC had worse survival outcomes compared with TN-IDC. Poor prognosis for MBC was likely caused by frequent recurrence with high initial stage and the unique biology of MBC itself.
- invasive ductal carcinoma
- metaplastic carcinoma
- triple-negative breast cancer
- breast cancer
Funding No direct funding was received for the study.
Competing interests None.
Patient consent This is a retrospective study and we did not perform any invasive procedures or additional studies. The results of pathological report aimed at therapeutic procedures and clinical information were only used, although again it was reviewed retrospectively. It was exempted from consent by IRB.
Ethics approval Ethics approval was provided by National Cancer Center, Korea.
Provenance and peer review Not commissioned; externally peer reviewed.