Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Duke University School of Medicine, Durham, NC, USA.
Ann Surg Oncol. 2018 Aug;25(8):2249-2260. doi: 10.1245/s10434-018-6533-3. Epub 2018 May 31.
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.
背景： 化生性乳腺癌（MBC）的特征是化疗耐药和血行播散。我们试图确定与改善 MBC 结局和增加 MBC 诊断可能性相关的因素。
方法： 在国家癌症数据库中，确定了 2010 年至 2014 年间诊断为 I-III 期 MBC 和非 MBC 的年龄≥18 岁的女性。Kaplan-Meier 和多变量 Cox 比例风险模型用于估计与总生存（OS）相关的因素。多变量逻辑回归确定了与 MBC 诊断相关的因素。
结果： 总体而言，纳入了 2451 例 MBC 和 568057 例非 MBC 患者；MBC 患者中 70.3%为三阴性（p<0.001），而非 MBC 患者中仅 11.3%为三阴性。与非 MBC 患者相比，整个队列中 MBC 患者的 5 年 OS 降低（72.7% vs. 87.5%），三阴性患者中 OS 降低（71.1% vs. 77.8%；均 p<0.001）。在 MBC 中，三阴性（与管腔）亚型与较差的 OS 无关（风险比[HR]1.16，95%置信区间[CI]0.88-1.54，p=0.28）。与非 MBC 患者相比，MBC 患者更有可能接受乳房切除术（59.0% vs. 44.9%）、化疗（74.1% vs. 43.1%）和腋窝淋巴结清扫术（ALND；35.2% vs. 32.2%，均 p≤0.001）。MBC 患者中，ALND（pN0）阴性的比例高于非 MBC 患者（20.0% vs. 10.6%，p<0.001）。在 MBC 患者中，化疗（HR 0.69，95%CI 0.53-0.89，p=0.004）和放疗（HR 0.52，95%CI 0.39-0.69，p<0.001）与生存改善相关，而 ALND 与生存降低相关（HR 1.37，95%CI 1.06-1.77，p=0.02）。
结论： MBC 患者的生存状况比非 MBC 患者差，与受体状态无关，这表明 MBC 可能带来额外的生存劣势。多模式治疗与改善结局相关，但 ALND 无效，并且在 MBC 中可能过度使用。
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