Shojaeian Fatemeh, Vasigh Mahtab, Del Calvo Haydee, Chaves Lourdes G, Jones Miranda R, Santa-Maria Cesar, Nimmagadda Gayatri, Sogunro Olutayo
Department of Surgery,Division of Breast Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
Ann Surg Oncol. 2025 Sep 10. doi: 10.1245/s10434-025-17937-y.
This study analyzed a large national cohort to compare treatment strategies and survival outcomes in metaplastic breast cancer (MtBC), a rare and aggressive subtype with poor treatment response.
Adult female patients with MtBC diagnosed between 2006 and 2021 were identified from the National Cancer Database and grouped by chemotherapy sequence (neoadjuvant vs. adjuvant) to evaluate clinical characteristics and survival outcomes.
Among 9526 patients, 30.1% received neoadjuvant and 69.9% adjuvant chemotherapy. The cohort was predominantly white (76.7%) and non-Hispanic (90.8%), with a median age of 60 years; most had a comorbidity score of 0 (81%). Neoadjuvant therapy use increased from 14.3 to 43.9% and was more common among younger patients with advanced clinical stages. The immunotherapy administration grew from 0 to 23.95%. Over a mean follow-up of 69 months, 5-year overall survival was higher in the adjuvant group (80.7% vs. 66.7%). In multivariable analysis, adjuvant therapy was associated with improved overall survival [hazard ratio (HR) 0.65; 95% CI 0.54-0.72; p < 0.001]. Mastectomy, radiation, and higher income level were also linked to improved outcomes, while older age, nodal involvement, comorbidities, and lymphovascular invasion were associated with higher mortality.
Adjuvant chemotherapy and aggressive local treatments were associated with improved survival, supporting a tailored approach that includes upfront surgery followed by adjuvant therapy as a potentially optimal strategy for operable cases. Meanwhile, the increasing use of neoadjuvant chemotherapy has coincided with rising survival rates, and the integration of immunotherapy into neoadjuvant regimens is also promising, highlighting the need for future studies.
本研究分析了一个大型全国队列，以比较化生性乳腺癌（MtBC）的治疗策略和生存结果，MtBC是一种罕见且侵袭性强、治疗反应差的亚型。
从国家癌症数据库中识别出2006年至2021年间确诊的成年女性MtBC患者，并按化疗顺序（新辅助化疗与辅助化疗）分组，以评估临床特征和生存结果。
在9526例患者中，30.1%接受新辅助化疗，69.9%接受辅助化疗。该队列主要为白人（76.7%）和非西班牙裔（90.8%），中位年龄为60岁；大多数患者的合并症评分为0（81%）。新辅助治疗的使用率从14.3%增至43.9%，在临床分期较晚的年轻患者中更为常见。免疫治疗的应用从0增至23.95%。平均随访69个月，辅助化疗组的5年总生存率更高（80.7%对66.7%）。在多变量分析中，辅助化疗与总生存率提高相关[风险比（HR）0.65；95%置信区间0.54 - 0.72；p < 0.001]。乳房切除术、放疗和较高收入水平也与较好的结果相关，而年龄较大、淋巴结受累、合并症和淋巴管浸润与较高死亡率相关。
辅助化疗和积极的局部治疗与生存率提高相关，支持一种个体化方法，即对于可手术病例，采用先行手术然后辅助治疗作为潜在的最佳策略。同时，新辅助化疗使用的增加与生存率上升相一致，将免疫治疗纳入新辅助治疗方案也很有前景，凸显了未来研究的必要性。
