Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2018 Nov 15;124(22):4314-4321. doi: 10.1002/cncr.31757. Epub 2018 Oct 11.
Both patients with inflammatory breast cancer (IFLBC) and patients with noninflammatory T4 breast cancer (non-IFLBC) have a heavy disease burden in the breast; whether the unique biology of IFLBC conveys a higher locoregional recurrence (LRR) risk and worse outcomes in comparison with other T4 lesions is uncertain. Here the outcomes of patients with IFLBC and patients with non-IFLBC treated with modern multimodality therapy are compared.
Patients with nonmetastatic T4 breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiation therapy between 2006 and 2016 were identified. Recurrences and survival were compared between patients with IFLBC and patients with non-IFLBC overall and stratified by receptor subtype.
For 199 T4 patients, the median age was 52 years, and the median clinical tumor size was 7 cm. One hundred seventeen (59%) had IFLBC. With a median follow-up of 41 months, 4 patients had isolated LRR; all cases occurred in patients with IFLBC. The 5-year isolated LRR rate for patients with IFLBC was 4.8%. Overall, 14 patients had both LRR and distant recurrence (DR); 47 had DR only. The 5-year distant recurrence-free survival (DRFS) rates were similar for patients with IFLBC and patients with non-IFLBC (63% vs 71%; log-rank P = .14). The 5-year DRFS rate was lowest among triple-negative (TN) patients (43%) and was significantly lower for patients with TN IFLBC versus patients with non-IFLBC (28% vs 62%; log-rank P = .02). The 5-year overall survival rates (71% vs 74%; log-rank P = .4) and cancer-specific survival rates (74% vs 79%; log-rank P = .23) did not differ between IFLBC and non-IFLBC.
Although IFLBC is often considered a unique biologic subtype, patients with IFLBC and patients with non-IFLBC had similar outcomes with modern multimodality therapy; isolated LRR was uncommon. The TN subtype in patients with IFLBC is associated with poor outcomes, and this indicates the need for new treatment approaches in this group.
炎性乳腺癌（IFLBC）患者和非炎性 T4 期乳腺癌（非-IFLBC）患者的乳房疾病负担都很重；IFLBC 的独特生物学是否比其他 T4 病变具有更高的局部区域复发（LRR）风险和更差的预后尚不确定。在这里，比较了接受现代多模式治疗的 IFLBC 患者和非-IFLBC 患者的结局。
确定了 2006 年至 2016 年间接受新辅助化疗、乳房切除术和放射治疗的非转移性 T4 期乳腺癌患者。比较了 IFLBC 患者和非-IFLBC 患者的总体复发率和生存率，并按受体亚型进行分层。
199 名 T4 患者中，中位年龄为 52 岁，中位临床肿瘤大小为 7cm。117 例（59%）为 IFLBC。中位随访 41 个月，4 例患者发生孤立性 LRR；所有病例均发生在 IFLBC 患者中。IFLBC 患者的 5 年孤立性 LRR 率为 4.8%。总体而言，14 例患者同时发生 LRR 和远处复发（DR）；47 例患者仅发生 DR。IFLBC 患者和非-IFLBC 患者的 5 年无远处复发生存率（DRFS）相似（63% vs 71%；对数秩 P=0.14）。三阴性（TN）患者的 5 年 DRFS 率最低（43%），且 TN IFLBC 患者明显低于非-IFLBC 患者（28% vs 62%；对数秩 P=0.02）。IFLBC 患者和非-IFLBC 患者的 5 年总生存率（71% vs 74%；对数秩 P=0.4）和癌症特异性生存率（74% vs 79%；对数秩 P=0.23）无差异。
尽管 IFLBC 通常被认为是一种独特的生物学亚型，但接受现代多模式治疗的 IFLBC 患者和非-IFLBC 患者的结局相似；孤立性 LRR 并不常见。IFLBC 患者中的 TN 亚型与不良预后相关，这表明需要为该组患者提供新的治疗方法。
