Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Aug;28(8):4245-4253. doi: 10.1245/s10434-020-09430-5. Epub 2021 Jan 2.
Metaplastic breast carcinoma (MBC) is a rare, aggressive subtype of breast cancer associated with poorer overall survival than other triple-negative breast cancers. This study sought to compare survival outcomes among histologic subtypes of MBC with those of non-metaplastic triple-negative breast cancer.
Clinicopathologic and treatment data for all patients with non-metastatic, pure MBC undergoing surgery from 1995 to 2017 and for a large cohort of patients with other types of triple-negative breast cancer during that period were collected from an institutional database. The MBC tumors were classified as having squamous, spindle, heterologous mesenchymal, or mixed histology. Survival outcomes were compared using the Kaplan-Meier method.
Of 132 MBC patients, those with heterologous mesenchymal MBC (n = 45) had the best 5-year overall and breast cancer-specific survival (BCSS, 88%; 95% confidence interval [CI], 0.78-0.99), whereas those with squamous MBC had the worst survival (BCSS, 56%; 95% CI, 0.32-0.79). Overall survival, BCSS, and recurrence-free survival were worse for the patients with MBC than for the patients who had non-MBC triple-negative breast cancer, with a clinicopathologically adjusted recurrence hazard ratio of 2.4 (95% CI, 1.6-3.3; p < 0.001). Of the 10 MBC patients who received neoadjuvant chemotherapy, 4 progressed while receiving treatment, and 3 had no response.
Metaplastic breast carcinoma is associated with worse survival than other triple-negative breast cancers. The heterologous mesenchymal subtype is associated with the best survival, whereas the squamous subtype is associated with the worst survival. These data call for research to identify therapies tailored to MBC's unique biology.
化生性乳腺癌（MBC）是一种罕见的、侵袭性的乳腺癌亚型，其总体生存率较其他三阴性乳腺癌差。本研究旨在比较 MBC 的组织学亚型与非化生性三阴性乳腺癌的生存结局。
从机构数据库中收集了 1995 年至 2017 年间接受手术治疗的所有非转移性、纯 MBC 患者的临床病理和治疗数据，以及同期大量其他类型三阴性乳腺癌患者的数据。MBC 肿瘤分为鳞状细胞癌、梭形细胞癌、异源性间充质癌或混合组织学。采用 Kaplan-Meier 法比较生存结局。
在 132 例 MBC 患者中，异源性间充质 MBC（n=45）的 5 年总生存率和乳腺癌特异性生存率（BCSS）最好（88%，95%置信区间 [CI]，0.78-0.99），而鳞状 MBC 的生存率最差（BCSS，56%，95%CI，0.32-0.79）。与非 MBC 三阴性乳腺癌患者相比，MBC 患者的总体生存率、BCSS 和无复发生存率更差，经临床病理调整后的复发风险比为 2.4（95%CI，1.6-3.3；p<0.001）。在接受新辅助化疗的 10 例 MBC 患者中，4 例在治疗过程中进展，3 例无反应。
化生性乳腺癌的生存情况较其他三阴性乳腺癌差。异源性间充质亚型的生存情况最好，而鳞状亚型的生存情况最差。这些数据呼吁开展研究，以确定针对 MBC 独特生物学的靶向治疗。
