Beatty J David, Atwood Mary, Tickman Ronald, Reiner Maureen
Department of Surgery, Swedish Cancer Institute, Suite 400, 1221 Madison Street, Seattle, WA 98104, USA.
Am J Surg. 2006 May;191(5):657-64. doi: 10.1016/j.amjsurg.2006.01.038.
Metaplastic breast carcinoma (MBC) is a rare poorly differentiated breast cancer characterized by coexistence of ductal carcinoma with areas of matrix producing, spindle-cell, sarcomatous, or squamous differentiation; ER/PR/HER2 negativity; and a reputation for poor outcome.
The Swedish Cancer Institute prospective breast cancer database (> 6500 patients; 1990-2005) has 24 MBC cases that were compared with typical breast cancer cases matched for age, date of diagnosis, stage, and ER/PR/HER2 status.
The mean metaplastic primary tumor diameter was 2.5 cm. The histological/nuclear grade was high in 21 of 24 cases. No patient had distant metastasis. ER and/or PR receptor status was negative in all cases. HER2 was negative in 10 of 11 cases tested. EGFR (HER1) was positive in 7 of 7 cases tested. All patients had sentinel and/or axillary lymph node dissection and surgical resection; 18 received chemotherapy and 22 had radiation therapy. Four patients had distant recurrences 5 to 88 months from diagnosis. Five-year survival was 83% (95% confidence interval, 66-100%). Comparison with matched typical breast cancer cases revealed no major significant difference in multidisciplinary treatment patterns, recurrence, or survival.
MBC is associated with poor prognostic indicators, but outcomes comparable with matched typical breast cancer cases can be achieved with routine aggressive multidisciplinary care. Increased, expression of EGFR (HER1) provides an opportunity for targeted tumor therapy.
化生性乳腺癌（MBC）是一种罕见的低分化乳腺癌，其特征为导管癌与产生基质、梭形细胞、肉瘤样或鳞状分化区域共存；雌激素受体（ER）/孕激素受体（PR）/人表皮生长因子受体2（HER2）阴性；且预后较差。
瑞典癌症研究所前瞻性乳腺癌数据库（>6500例患者；1990 - 2005年）中有24例MBC病例，将其与年龄、诊断日期、分期及ER/PR/HER2状态相匹配的典型乳腺癌病例进行比较。
化生性原发肿瘤平均直径为2.5厘米。24例中有21例组织学/核分级较高。无患者发生远处转移。所有病例的ER和/或PR受体状态均为阴性。检测的11例中有10例HER2为阴性。检测的7例中有7例表皮生长因子受体（EGFR，HER1）为阳性。所有患者均进行了前哨和/或腋窝淋巴结清扫及手术切除；18例接受了化疗，22例接受了放疗。4例患者在诊断后5至88个月出现远处复发。5年生存率为83%（95%置信区间，66 - 100%）。与匹配对照的典型乳腺癌病例相比，多学科治疗模式、复发或生存率无重大显著差异。
MBC与不良预后指标相关，但通过常规积极的多学科治疗可获得与匹配对照的典型乳腺癌病例相当的预后。EGFR（HER1）表达增加为靶向肿瘤治疗提供了机会。
