转移性炎性乳腺癌：全国多中心真实队列研究（ESME）中的生存结局和预后因素。

Metastatic inflammatory breast cancer: survival outcomes and prognostic factors in the national, multicentric, and real-life French cohort (ESME).

机构信息

Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France.

Biometrics Unit, Centre Léon Bérard, Lyon, France.

出版信息

ESMO Open. 2021 Aug;6(4):100220. doi: 10.1016/j.esmoop.2021.100220. Epub 2021 Jul 22.

DOI:10.1016/j.esmoop.2021.100220

PMID:34303929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8327489/

Abstract

BACKGROUND

Primary inflammatory breast cancer (IBC) is a rare and aggressive entity whose prognosis has been improved by multimodal therapy. However, 5-year overall survival (OS) remains poor. Given its low incidence, the prognosis of IBC at metastatic stage is poorly described.

MATERIALS AND METHODS

This study aimed to compare OS calculated from the diagnosis of metastatic disease between IBC patients and non-IBC patients in the Epidemiological Strategy and Medical Economics database (N = 16 702 patients). Secondary objectives included progression-free survival (PFS) after first-line metastatic treatment, identification of prognostic factors for OS and PFS, and evolution of survival during the study period.

RESULTS

From 2008 to 2014, 7465 patients with metastatic breast cancer and known clinical status of their primary tumor (T) were identified (582 IBC and 6883 non-IBC). Compared with metastatic non-IBC, metastatic IBC was associated with less hormone receptor-positive (44% versus 65.6%), more human epidermal growth factor receptor 2-positive (30% versus 18.6%), and more triple-negative (25.9% versus 15.8%) cases, more frequent de novo M1 stage (53.3% versus 27.7%; P < 0.001), and shorter median disease-free interval (2.02 years versus 4.9 years; P < 0.001). With a median follow-up of 50.2 months, median OS was 28.4 months [95% confidence interval (CI) 24.1-33.8 months] versus 37.2 months (95% CI 36.1-38.5 months) in metastatic IBC and non-IBC cases, respectively (P < 0.0001, log-rank test). By multivariate analysis, OS was significantly shorter in the metastatic IBC group compared with the metastatic non-IBC group [hazard ratio = 1.27 (95% CI 1.1-1.4); P = 0.0001]. Survival of metastatic IBC patients improved over the study period: median OS was 24 months (95% CI 20-31.9 months), 29 months (95% CI 21.7-39.9 months), and 36 months (95% CI 27.9-not estimable months) if diagnosis of metastatic disease was carried out until 2010, between 2011 and 2012, and from 2013, respectively (P = 0.003).

CONCLUSION

IBC is independently associated with adverse outcome when compared with non-IBC in the metastatic setting.

摘要

背景

原发性炎性乳腺癌（IBC）是一种罕见且侵袭性很强的实体瘤，采用多模式治疗后其预后得到了改善。然而，5 年总生存率（OS）仍然较差。鉴于其发病率低，转移性 IBC 的预后描述得很差。

材料和方法

本研究旨在比较在流行病学策略和医学经济学数据库（N=16702 例患者）中，IBC 患者和非 IBC 患者从转移性疾病诊断开始的 OS。次要目标包括一线转移性治疗后的无进展生存期（PFS）、确定 OS 和 PFS 的预后因素，以及在研究期间生存情况的演变。

结果

2008 年至 2014 年间，确定了 7465 例转移性乳腺癌且已知其原发性肿瘤（T）临床状态的患者（582 例 IBC 和 6883 例非 IBC）。与转移性非 IBC 相比，转移性 IBC 更可能为激素受体阳性（44%比 65.6%）、人表皮生长因子受体 2 阳性（30%比 18.6%）和三阴性（25.9%比 15.8%），更常为初发 M1 期（53.3%比 27.7%；P<0.001），且无疾病间隔更短（2.02 年比 4.9 年；P<0.001）。在中位随访 50.2 个月时，转移性 IBC 和非 IBC 患者的中位 OS 分别为 28.4 个月（95%CI 24.1-33.8 个月）和 37.2 个月（95%CI 36.1-38.5 个月）（P<0.0001，对数秩检验）。多变量分析显示，转移性 IBC 组的 OS 明显短于转移性非 IBC 组[风险比=1.27（95%CI 1.1-1.4）；P=0.0001]。转移性 IBC 患者的生存情况在研究期间有所改善：如果在 2010 年之前、2011 年至 2012 年之间或 2013 年之后进行转移性疾病诊断，转移性 IBC 患者的中位 OS 分别为 24 个月（95%CI 20-31.9 个月）、29 个月（95%CI 21.7-39.9 个月）和 36 个月（95%CI 27.9-不可估计个月）（P=0.003）。