Chemotherapy significantly improves long-term survival of small lesion node negative metaplastic breast carcinoma in T1c population rather than T1a and T1b

Chen, Qitong; Zhou, Qin; He, Hongyi; He, Yeqing; Yuan, Yunchang; Zou, Qiongyan; Yi, Wei

doi:10.1038/s41598-022-04946-0

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…These indicated that tumor biological behavior features should not be a barrier to BCS in CLBC. The improved survival for BCS was likely attributed to the advances in early diagnosis, surgery procedures, and adjuvant therapy over the last decades [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were observed in CLBC patients who received BCS. Tumor stage (tumor size, lymph node stage), biological features (grade, hormone receptor status, HER2 status), and chemotherapy have been investigated well to predict survival for breast cancer patients [ 24 , 25 , 38 , 39 ]. Marital status reflects the social, psychological, and economic conditions, which could affect the diagnosis, treatment, and prognosis of a female patient indirectly [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study

Yuan,

Liu,

et al. 2023

BMC Surg

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Background The evidence of breast-conserving therapy (BCT) applied in centrally located breast cancer (CLBC) is absent. This study aims to investigate the long-term survival of breast-conserving therapy (BCT) in centrally located breast cancer (CLBC) compared with mastectomy in CLBC and BCT in non-CLBC. Methods Two hundred ten thousand four hundred nine women with unilateral T1-2 breast cancer undergoing BCT or mastectomy were identified from the Surveillance, Epidemiology, and End Results database. Kaplan–Meier survival curves were assessed via log-rank test. Propensity score matching (PSM) was used to balance baseline features, and the multivariable Cox model was used to estimate the adjusted hazard ratio [HR] and its 95% confidence interval [CI] for breast cancer-specific survival (BCSS) and overall survival (OS). Results With a median follow-up of 91 months, the BCSS and OS rates in patients who received BCT were greater than those patients treated with mastectomy in the entire CLBC set. Multivariable Cox analyses showed that CLBC patients who received BCT had better BCSS (HR = 0.67, 95%CI: 0.55–0.80, p < 0.001) and OS (HR = 0.78, 95%CI: 0.68–0.90, p = 0.001) than patients who received a mastectomy, but there were no significant differences of BCSS (HR = 0.65, 95%CI: 0.47–0.90, p = 0.009) and OS (HR = 0.82, 95%CI: 0.65–1.04, p = 0.110) after PSM. In patients treated with BCT, CLBC patients had a similar BCSS (HR = 0.99, 95%CI: 0.87–1.12, p = 0.850) but a worse OS (HR = 1.09, 95%CI: 1.01–1.18, p = 0.040) compared to that of the non-CLBC patient, but there was no significant difference both BCSS (HR = 1.05, 95%CI: 0.88–1.24, p = 0.614) and OS (HR = 1.08, 95%CI: 0.97–1.20, p = 0.168) after PSM. Conclusion Our findings revealed that BCT should be an acceptable and preferable alternative to mastectomy for well-selected patients with CLBC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study

Yuan,

Liu,

et al. 2023

BMC Surg

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“…Studies based on the SEER database have a high clinical reference value because of large sample size and strong statistical efficacy. We have previously explored the impact of chemotherapy on the prognosis of patients with metaplastic breast carcinoma (MpBC) and compared the long-term prognosis of nipple-sparing mastectomy (NSM) vs. total mastectomy (TM) by analyzing different populations in the SEER database, providing large sample-based evidence for breast cancer treatment ( 39 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

Prognosis comparison between intraoperative radiotherapy and whole-breast external beam radiotherapy for T1–2 stage breast cancer without lymph node metastasis treated with breast-conserving surgery: A case–control study after propensity score matching

Chen

et al. 2022

Front. Med.

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BackgroundExternal beam radiotherapy (EBRT), an adjuvant to breast-conserving surgery (BCS), requires a long treatment period, is costly, and is associated with numerous complications. Large sample studies with long follow-up periods are lacking regarding whether intraoperative radiotherapy (IORT), an emerging radiotherapy modality, can replace EBRT for patients with T1–2 early stage breast cancer without lymph node metastasis treated with BCS.MethodsWe identified 270,842 patients with T1-2N0M0 breast cancer from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. A total of 10,992 patients were matched by propensity score matching (PSM). According to the radiotherapy method, the patients were divided into the IORT and EBRT groups. Overall survival (OS) and breast cancer-specific survival (BCSS) rates were analyzed and compared between the IORT and EBRT groups by Kaplan–Meier analysis. Bilateral P < 0.05 was considered to indicate significance.ResultsAfter PSM, the survival analysis showed no significant differences in OS or BCSS rates between the IORT and EBRT groups. In the subgroup analysis, the IORT population diagnosed from 2010 to 2013 (HRs = 0.675, 95% CI 0.467–0.976, P = 0.037) or with T2 stage (HRs = 0.449, 95% CI 0.261–0.772, P = 0.004) had better OS rates, but in the overall population, the OS and BCSS rates were better in patients with T1 stage than in patients with T2 stage (P < 0.0001), and the proportion of chemotherapy was significantly higher in T2 stage than in T1 stage. Patients who had EBRT with unknown estrogen receptor had better OS rates (HRs = 3.392, 95% CI 1.368–8.407, P = 0.008). In addition, the IORT group had better BCSS rates for married (HRs = 0.403, 95% CI 0.184–0.881, P = 0.023), grade III (HRs = 0.405, 95% CI 0.173–0.952, P = 0.038), and chemotherapy-receiving (HRs = 0.327, 95% CI 0.116–0.917, P = 0.034) patients with breast cancer compared to the EBRT group.ConclusionIntraoperative radiotherapy results of non-inferior OS and BCSS rates, compared to those of EBRT, in patients with early stage breast cancer without lymph node metastasis treated with BCS, and IORT may provide substantial benefits to patients as an effective alternative to standard treatment. This finding provides new insights into radiotherapy strategies for early stage breast cancer.

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“…Although there has been some bene t shown to chemotherapy in these patients, little evidence compares adjuvant to neoadjuvant chemotherapy. Early surgical resection has been shown to be of bene t in earlystage cancers, 15 but treatment of later stage disease is still debated. Rates of complete pathological response with neoadjuvant therapy are low with MpBC, but the available evidence shows a similar overall survival between neoadjuvant and adjuvant chemotherapy in patients with node positive disease as was the case with this patient 13 .…”

Section: Discussion Conclusionmentioning

confidence: 99%

Mixed Metaplastic Carcinoma of the Breast: A Case Report

Tower

Hughes

Moore

et al. 2022

Preprint

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Background: Metaplastic carcinoma (MpBC) of the breast is an exceedingly rare group of malignancies that accounts for 0.2–5% of all breast cancers. As such, there is no current consensus on standardized treatment, and physicians often rely on case reports to help guide their understanding of this cancer as well as help formulate the most optimal treatment options for their patients. The following case consists of metaplastic carcinoma of the breast with biopsy proven squamous axillary disease. This case report includes the multidisciplinary treatment of MpBC which consisted of neoadjuvant chemotherapy that resulted in a near complete pathologic response on surgical pathology. Thus, we present a rare case of mixed metaplastic breast carcinoma with unusual metastatic disease and confirming the utility of treatment of neoadjuvant chemotherapy in this population of patients. Case presentation: A 68 year-old Caucasian woman with no significant past medical or family history discovered a lump incidentally in her left breast with no associated signs or symptoms. The patient had received no annual mammogram screenings and did not do self-examinations regularly. The patient’s initial diagnostic imaging revealed a 4.6 cm irregular mass at 11:00 categorized as a BI-RADS 5 as well as a suspicious enlarged axillary lymph node and an area of 2.5 cm of heterogeneous calcifications in the 3 o'clock position. She then subsequently underwent an ultrasound-guided core needle biopsy of the left breast 11:00 lesion as well as axillary lymph node and also had a stereotactic core needle biopsy of the calcifications. The 4.6cm lesion was revealed to be infiltrating ductal carcinoma with a minor squamous component, mixed metaplastic carcinoma, that was strongly ER (100+)/PR (100+) positive, HER-2/Neu (2+ equivocal on immunohistochemistry) negative on fluorescence in situ hybridization (FISH). The 2.5cm calcifications were revealed to be ductal carcinoma in situ. No prognostics were able to be performed due to the scant sample size. The lymph node biopsy revealed metastatic keratinizing squamous cell carcinoma with a minor component resembling the breast tumor that was weakly positive for ER (5+), negative for PR, equivocal per IHC, and negative on FISH. The patient completed neoadjuvant chemotherapy, and based on interval physical exams and diagnostic imaging, she had an excellent response. After multidisciplinary discussion and very thorough surgical counseling, the patient elected for breast conservation therapy and underwent a left wireless localized partial mastectomy of the biopsy proven carcinomas with a left targeted axillary dissection. The surgical pathology revealed a near complete pathologic response with only 8mm residual tumor remaining as well as a negative conversion of the clipped axillary node. · Conclusions: Due to advanced locoregional disease at the time of diagnosis, as well as historically poor responses to neoadjuvant chemotherapy, patients diagnosed with metaplastic breast carcinoma often proceed with invasive surgery as the initial treatment. This case, however, demonstrates the successful implementation for a very rare pathology with a near complete pathologic response to neoadjuvant chemotherapy. Therefore, this case demonstrates the utilization of neoadjuvant chemotherapy as the initial treatment in patients with metaplastic breast carcinoma.

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Chemotherapy significantly improves long-term survival of small lesion node negative metaplastic breast carcinoma in T1c population rather than T1a and T1b

Cited by 5 publications

References 26 publications

Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study

Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study

Prognosis comparison between intraoperative radiotherapy and whole-breast external beam radiotherapy for T1–2 stage breast cancer without lymph node metastasis treated with breast-conserving surgery: A case–control study after propensity score matching

Mixed Metaplastic Carcinoma of the Breast: A Case Report

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