Department of Breast Surgery, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, Shandong, China
J Clin Pathol. 2019 Jun;72(6):418-424. doi: 10.1136/jclinpath-2018-205544. Epub 2019 Mar 14.
Triple-negative breast cancer comprises different histological subtypes, including metaplastic breast cancer (MBC) and ductal carcinomas (IDCs). The purpose of this study was to compare triple-negative MBC (TN-MBC) with triple-negative IDC (TN-IDC) in terms of survival and predictive factors.
With access to the Surveillance, Epidemiology and End Result (SEER) database, a total of 19 383 patients met the eligibility criteria. Clinicopathological characteristics were compared between groups using the χ test. Univariate and multivariate analyses were applied to evaluate the disease-specific survival (DSS) and overall survival (OS). Subgroup analyses summarised the hazard ratios of TN-MBC versus TN-IDC using a forest plot.
A total of 586 patients with TN-MBC and 18 797 with TN-IDC were included in this study. Patients with TN-MBC were older and presented with larger tumour sizes, relatively rare lymph node positive disease, and had received more chemotherapy. Compared with TN-IDC, the TN-MBC group showed a significantly poorer prognosis before and after the 1:3 matched case-control analysis. Further subgroup analysis indicated that patients with TN-MBC were older, were from specific races, and those with distant metastasis and not receiving radiotherapy had worse prognosis than patients with TN-IDC in terms of DFS and OS.
Our results showed that patients with TN-MBC had unique clinicopathological characteristics and poorer prognostic subtype compared with TN-IDC. This improves our understanding of the clinicopathological and prognostic features of this rare entity but also provides more convincing therapeutic guidelines for TN-MBC in patients with breast cancer.
三阴性乳腺癌包括不同的组织学亚型，包括化生性乳腺癌（MBC）和导管癌（IDC）。本研究旨在比较三阴性 MBC（TN-MBC）与三阴性 IDC（TN-IDC）在生存和预测因素方面的差异。
通过访问监测、流行病学和最终结果（SEER）数据库，共有 19383 名符合入选标准的患者。使用 χ 检验比较组间的临床病理特征。应用单因素和多因素分析评估疾病特异性生存（DSS）和总生存（OS）。使用森林图对 TN-MBC 与 TN-IDC 的危险比进行亚组分析。
本研究共纳入 586 例 TN-MBC 患者和 18797 例 TN-IDC 患者。TN-MBC 患者年龄较大，肿瘤较大，淋巴结阳性疾病相对少见，接受了更多的化疗。与 TN-IDC 相比，TN-MBC 组在 1:3 匹配病例对照分析前后均表现出明显较差的预后。进一步的亚组分析表明，与 TN-IDC 相比，TN-MBC 组患者年龄较大，来自特定种族，远处转移且未接受放疗的患者在 DFS 和 OS 方面预后较差。
我们的结果表明，与 TN-IDC 相比，TN-MBC 患者具有独特的临床病理特征和较差的预后亚型。这提高了我们对这种罕见实体的临床病理和预后特征的认识，但也为乳腺癌患者的 TN-MBC 提供了更有说服力的治疗指南。
