Metaplastic Breast Cancer: Clinicopathological Features and Its Prognosis

J Clin Pathol. 2012 May;65(5):441-6. doi: 10.1136/jclinpath-2011-200586. Epub 2012 Mar 12.

Abstract

Aims: The prognosis of metaplastic breast cancer (MBC) is reportedly worse than that of triple-negative invasive ductal carcinoma (TN-IDC), but the determinants of poor prognosis are not yet known.

Methods: Patients from two Korean cancer centres were included in this study (67 MBC and 520 TN-IDC). Characteristics of the two disease groups, including clinical parameters, histological features, chemoresponsiveness, disease recurrence and survival estimates, were evaluated.

Results: MBC presented with larger tumours, more frequent distant metastasis and higher histological grade compared with TN-IDC (p<0.001). All but nine patients with MBC had triple-negative disease. Disease-free survival and overall survival (OS) of MBC were worse than TN-IDC (p<0.001). Multivariable analysis of disease-free survival revealed MBC type as an independent prognostic factor (HR 2.53; 95% CI 1.32 to 4.84) along with lymph node metastasis and implementation of breast conserving surgery. For OS, MBC type remained a significant prognostic factor (HR 2.56; 95% CI 1.18 to 5.54). Chemoresponsiveness of MBC and TN-IDC were similar in both neoadjuvant (p=1.000) and advanced disease settings (p=0.508). For a given MBC type, risk factors for disease recurrence included the presence of a squamous component (HR 4.0; 95% CI 1.46 to 10.99) and lymph node metastasis (HR 4.76; 95% CI 1.67 to 13.60); the risk factor for OS was initial distant metastasis (HR 10.77; 95% CI 2.59 to 44.76).

Conclusions: MBC had worse survival outcomes compared with TN-IDC. Poor prognosis for MBC was likely caused by frequent recurrence with high initial stage and the unique biology of MBC itself.

Publication types

  • Multicenter Study

MeSH terms

  • Biomarkers, Tumor / analysis
  • Breast / pathology*
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology*
  • Carcinoma, Ductal, Breast / chemistry
  • Carcinoma, Ductal, Breast / drug therapy
  • Carcinoma, Ductal, Breast / mortality
  • Carcinoma, Ductal, Breast / secondary*
  • Disease-Free Survival
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Mastectomy, Segmental / methods
  • Metaplasia
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Receptor, ErbB-2 / analysis
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Republic of Korea / epidemiology
  • Survival Rate

Substances

  • Biomarkers, Tumor
  • Receptors, Estrogen
  • Receptors, Progesterone
  • ERBB2 protein, human
  • Receptor, ErbB-2