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Factors associated with improved outcomes for metastatic inflammatory breast cancer patients

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Controversy exists regarding the role of locoregional therapy for stage IV inflammatory breast cancer (IBC). This study aims to determine indicators of prognosis, including primary tumor resection, for stage IV IBC patients.

Methods

Using the National Cancer Data Base, female patients diagnosed 2010–2013 with unilateral a priori metastatic T4d invasive adenocarcinoma of the breast were identified. We conducted propensity score matched analysis to balance confounders of surgery versus no-surgery. Stratified log-rank test and double-robust estimation under the Cox model were used to assess the effect of surgery, and margins, on overall survival (OS) in the propensity score matched cohort.

Results

Of 1266 patients, 41% underwent surgery. In the unmatched cohort, median OS of the surgery and no-surgery groups was 36 and 20 months, respectively (p < 0.001). In the matched cohort (n = 588), the median OS of surgery and no-surgery groups was 29 and 27 months, respectively (p = 0.052). Patients with negative margin surgery (p = 0.024), hormone receptor-positive (p = 0.019), HER2-positive disease (p < 0.0001), treated with chemotherapy (p < 0.0001) and hormonal therapy (p < 0.0001), had better survival. Those with brain metastases had increased risk of death (p < 0.0001).

Conclusion

This study represents the largest cohort of metastatic IBC patients, and identified negative margin surgery, systemic therapy, hormone receptor and HER2-positive disease as factors associated with improved outcomes. While these findings should be interpreted cautiously, they may be used to guide further investigations into local control and quality of life in this patient population with limited treatment options.

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Funding

Morgan Welch Inflammatory Breast Cancer Research Program, and State of Texas Rare and Aggressive Breast Cancer Research Program Grant.

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Authors and Affiliations

  1. Department of Surgical Oncology, Brigham and Women’s Hospital, 450 Brookline Ave, Suite 1470, Boston, MA, 02215, USA

    Anna Weiss

  2. Division of Surgical Oncology, St. Lukes’s Boise Surgical Group, Meridian, ID, USA

    Rhiana S. Menen

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Y. Lin & Yu Shen

  4. Division of Breast Surgical Oncology, MD Anderson Banner, Phoenix, AZ, USA

    Kelly J. Rosso

  5. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Simona Shaitelman & Wendy Woodward

  6. Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, TX, USA

    Wendy Woodward, Vicente Valero, Naoto T. Ueno & Gildy Babiera

  7. Department of Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Vicente Valero & Naoto T. Ueno

  8. Department of Breast Surgical Oncology, University of Texas MD Anderson, Houston, TX, USA

    Isabelle Bedrosian & Gildy Babiera

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  1. Anna Weiss
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Correspondence to Anna Weiss.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

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Weiss, A., Menen, R.S., Lin, H.Y. et al. Factors associated with improved outcomes for metastatic inflammatory breast cancer patients. Breast Cancer Res Treat 169, 615–623 (2018). https://doi.org/10.1007/s10549-018-4715-0

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