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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2018

01-08-2018 | Breast Oncology

Metaplastic Breast Cancer Treatment and Outcomes in 2500 Patients: A Retrospective Analysis of a National Oncology Database

Authors: Cecilia T. Ong, MD, Brittany M. Campbell, BS, Samantha M. Thomas, MS, Rachel A. Greenup, MD, Jennifer K. Plichta, MD, Laura H. Rosenberger, MD, Jeremy Force, DO, Allison Hall, MD, Terry Hyslop, PhD, E. Shelley Hwang, MD, Oluwadamilola M. Fayanju, MD

Published in: Annals of Surgical Oncology | Issue 8/2018

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Abstract

Background

Metaplastic breast cancer (MBC) is characterized by chemoresistance and hematogenous spread. We sought to identify factors associated with improved MBC outcomes and increased likelihood of MBC diagnosis.

Methods

Women ≥ 18 years of age with stage I–III MBC and non-MBC diagnosed between 2010 and 2014 were identified in the National Cancer Data Base. Kaplan–Meier and multivariate Cox proportional hazards models were used to estimate associations with overall survival (OS). Multivariate logistic regression identified factors associated with MBC diagnosis.

Results

Overall, 2451 MBC and 568,057 non-MBC patients were included; 70.3% of MBC vs. 11.3% of non-MBC patients were triple negative (p < 0.001). Five-year OS was reduced among MBC vs. non-MBC patients for the entire cohort (72.7 vs. 87.5%) and among triple-negative patients (71.1 vs. 77.8%; both p < 0.001). In MBC, triple-negative (vs. luminal) subtype was not associated with worse OS (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.88–1.54, p = 0.28). Compared with non-MBC patients, MBC patients were more likely to receive mastectomy (59.0 vs. 44.9%), chemotherapy (74.1 vs. 43.1%), and axillary lymph node dissection (ALND; 35.2 vs. 32.2%, all p ≤ 0.001). MBC patients more frequently had negative ALND (pN0) than non-MBC patients (20.0 vs. 10.6%, p < 0.001). Among MBC patients, chemotherapy (HR 0.69, 95% CI 0.53–0.89, p = 0.004) and radiotherapy (HR 0.52, 95% CI 0.39–0.69, p < 0.001) were associated with improved survival, while ALND was associated with decreased survival (HR 1.37, 95% CI 1.06–1.77, p = 0.02).

Conclusions

MBC patients had worse survival than non-MBC patients, independent of receptor status, suggesting that MBC may confer an additional survival disadvantage. Multimodal therapy was associated with improved outcomes, but ALND was not and may be overutilized in MBC.
Appendix
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Metadata
Title
Metaplastic Breast Cancer Treatment and Outcomes in 2500 Patients: A Retrospective Analysis of a National Oncology Database
Authors
Cecilia T. Ong, MD
Brittany M. Campbell, BS
Samantha M. Thomas, MS
Rachel A. Greenup, MD
Jennifer K. Plichta, MD
Laura H. Rosenberger, MD
Jeremy Force, DO
Allison Hall, MD
Terry Hyslop, PhD
E. Shelley Hwang, MD
Oluwadamilola M. Fayanju, MD
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6533-3

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