Outcome of inflammatory breast cancer in Moroccan patients: clinical, molecular and pathological characteristics of 219 cases from the National Oncology Institute (INO)

Abstract

BackgroundUsually misdiagnosed, Inflammatory Breast Cancer (IBC) is the most aggressive form of non-metastatic breast cancer. This orphan disease is more frequent in North Africa. Despite intensive treatment, the survival rate remains very low.MethodsWe have retrospectively studied all breast cancer cases diagnosed at the National Oncology Institute (INO), Rabat between 2005 and 2010. We have collected 219 cases of women with metastatic and non-metastatic IBC. Data have been obtained from patients’ personal medical files over a follow-up period of 5 years. We have described IBC’s clinicopathological features and analyzed its clinical outcome using SPSS software. HR (hazard Ratio) was calculated using Cox regression analysis.ResultsThe frequency of IBC cases is 4.05%. The majority of our patients (65.3%) were under 50 years old. The most prevalent molecular subtype was Luminal A (38.7%) followed by Luminal B HER2+ (27.9%) and Triple negative (21.6%).During the follow-up period, 72 patients (32.9%) had recurrence and 40 patients (18.3%) died. The 3-year OS (Overall Survival) and EFS (Event Free Survival) of non-metastatic patients were 70.4 and 46.5% respectively, while in the metastatic disease, the 3-year OS was only 41.9%. In non-metastatic women, we observed a higher rate of EFS associated to Selective estrogen receptor modulation treatment (p = 0.01), and a lower rate EFS in triple negative breast cancer patients (p = 0.02). In univariate analysis, we found that EFS rate is lower in patients presenting Triple Negative tumors when compared to other molecular subtypes (HR: 3.54; 95%CI: 1.13–11.05; p = 0.02). We also found that Selective estrogen receptor modulation treatment is associated with higher EFS rate (HR: 0.48; 95%CI: 0.07–0.59; p = 0.01).ConclusionsIBC in Morocco shows similar characteristics to those in North African countries; however, survival rates are still the highest when compared with neighboring countries. Collaborative studies with prospective aspects are warranted to establish the epidemiological profile and understand the high frequencies of IBC in North Africa. More studies on molecular markers are also needed to improve IBC patients’ management and eventually their survival rate.

Clinico-pathologic and mammographic characteristics of inflammatory and non-inflammatory breast cancer at six centers in North Africa

“…Our findings with regard to hormone receptor expression, tumor histology, and presence of tumor emboli in the dermal lymphatics in IBC and non-IBC cases are similar to other studies (11)(12)(13)(14)19,22). Mammographic evidence of skin thickening and stromal coarsening/ thickened trabeculations among IBC cases was less common and axillary adenopathy (17,23) and a detected mass (17,20,23) were more common than reported in other studies.…”

“…The prevalence of erythema, edema, and peau d'orange was generally higher and duration of these signs among IBC cases generally shorter in our study than in other studies in North Africa (10)(11)(12), which were based on medical record review (except for the Egyptian cases in reference 11). Notably, deficiencies in the information in medical records needed to identify IBC cases have been described (25).…”

“…Here we describe the clinico-pathologic and mammographic characteristics of the IBC and non-IBC cases included in this study, expanding upon previous studies (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). We also evaluate cases by photographic review and adherence to the two most recent definitions of IBC: the international expert panel consensus statement for standardized diagnosis (7) and the American Joint Committee on Cancer (AJCC) 8 th edition definition, which expands on the 7 th edition definition (which we used in our study) by considering duration history of symptoms/signs (2).…”

Inflammatory Breast Cancer: A Literature Review

“…The incidence of IBC varies considerably in different regions around the world. Studies have shown that IBC is more common in North Africa than in other parts of the world; the most recent estimates suggest that it represents 5% to 7% of all breast cancers in Tunisia [ 4 ], 4% to 5 % in Morocco [ 5 ], while in Egypt it has a rate of 11% [ 6 ]. IBC is also characterized by rapid progression and higher metastatic potential [ 2 ].…”

Proactive Immunotherapeutic Approaches against Inflammatory Breast Cancer May Improve Patient Outcomes

“…This immunotherapeutic approach could be very attractive for IBC patients in North African countries; the IBC incidence ranges from ~5% to 11% of total breast cancers in Morocco, Algeria, Tunisia, and Egypt [ 22 , 56 , 57 , 58 ], making this specific disease a high economic burden for these countries. Hence, it is hard to disagree with Fahrer’s conclusion that “CFA therefore has the potential to be a simple and inexpensive form of cancer immunotherapy, accessible for use in both developed and emerging economies” [ 54 ].…”