Department of Surgery, Mayo Clinic, Rochester, MN.
Department of Surgery, Mayo Clinic, Rochester, MN.
Clin Breast Cancer. 2018 Aug;18(4):e501-e506. doi: 10.1016/j.clbc.2017.10.003. Epub 2017 Oct 7.
Few data exist on the influence of tumor biologic subtype on treatment response and outcomes for inflammatory breast cancer (IBC). We examined a contemporary cohort of IBC patients treated with current targeted systemic therapies, selected on the basis of tumor biologic subtype, to evaluate pathologic treatment response and cancer outcomes across biologic subtypes.
We studied 57 clinical stage T4dM0 IBC patients operated on at our institution from October 2008 to July 2015. Comparisons across biologic subtypes were performed by Wilcoxon rank-sum or chi-square tests; Kaplan-Meier and log-rank tests were used to analyze survival outcomes.
All patients received neoadjuvant systemic therapy; 54 (95%) completed postmastectomy radiation. Ninety-one percent (52/57) had clinically node-positive disease at presentation. Pathologic complete response (pCR) rates in the breast and axilla differed significantly by approximated biologic subtype, defined as estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER-2) negative; and HER-2 positive and ER negative/HER-2 negative (all P < .001). After 50 months' median follow-up, 20 patients experienced disease recurrence. Site of first relapse was distant in 80% (16/20). Disease-free survival (DFS) and breast cancer-specific survival (BCSS) differed significantly by biologic subtype. Five-year DFS was 46% for patients with ER-positive/HER-2-negative tumors, 82% for HER-2-positive tumors, and 33% for ER-negative/HER-2-negative tumors (P < .001), while 5-year BCSS was 76%, 100%, and 57%, respectively (P = .02)-notably better than historic reports.
Our data show that both treatment response and outcomes vary significantly across IBC biologic subtypes. Multimodal treatment and modern systemic therapies have markedly improved DFS and BCSS. These data provide further evidence to suggest that IBC is not a distinct biologic entity transcending standard breast tumor marker subclassification.
关于肿瘤生物学亚型对炎性乳腺癌（IBC）治疗反应和结局的影响，目前数据有限。我们研究了一组接受当前基于肿瘤生物学亚型选择的靶向全身治疗的当代 IBC 患者，以评估生物学亚型之间的病理治疗反应和癌症结局。
我们研究了 2008 年 10 月至 2015 年 7 月在我院手术的 57 例临床分期 T4dM0 IBC 患者。通过 Wilcoxon 秩和检验或卡方检验比较生物学亚型；Kaplan-Meier 和对数秩检验用于分析生存结局。
所有患者均接受新辅助全身治疗；54 例（95%）完成了乳房切除术后放疗。91%（52/57）患者在就诊时存在临床淋巴结阳性疾病。乳腺和腋窝的病理完全缓解（pCR）率根据近似生物学亚型显著不同，定义为雌激素受体（ER）阳性/人表皮生长因子受体 2（HER-2）阴性；和 HER-2 阳性和 ER 阴性/HER-2 阴性（均 P<0.001）。中位随访 50 个月后，20 例患者出现疾病复发。80%（16/20）的患者首次复发为远处转移。无病生存（DFS）和乳腺癌特异性生存（BCSS）显著因生物学亚型而异。ER 阳性/HER-2 阴性肿瘤患者的 5 年 DFS 为 46%，HER-2 阳性肿瘤患者为 82%，ER 阴性/HER-2 阴性肿瘤患者为 33%（P<0.001），而 5 年 BCSS 分别为 76%、100%和 57%（P=0.02）-明显优于历史报告。
我们的数据表明，IBC 的治疗反应和结局在不同的生物学亚型之间有显著差异。多模式治疗和现代全身治疗显著提高了 DFS 和 BCSS。这些数据进一步证明，IBC 不是超越标准乳腺癌肿瘤标志物分类的独特生物学实体。
