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Annals of Surgical Oncology

, Volume 25, Issue 4, pp 928–936 | Cite as

Metaplastic Breast Cancer: Practice Patterns, Outcomes, and the Role of Radiotherapy

  • Waqar Haque
  • Vivek Verma
  • Nilan Naik
  • E. Brian Butler
  • Bin S. TehEmail author
Breast Oncology

Abstract

Purpose

Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer with limited data to guide management. This study of a large, contemporary US database described national practice patterns and addressed the impact of radiotherapy (RT) on survival.

Methods

The National Cancer Data Base was queried (2004–2013) for women with non-metastatic MBC. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan–Meier analysis evaluated overall survival (OS) between patients treated with either lumpectomy or mastectomy with or without RT, while substratifying patients into pT1–2N0 and pT3–4/N+ subcohorts. Cox proportional hazards modeling determined variables associated with OS.

Results

Of 5211 total patients, 447 (9%) had lumpectomy alone, 1831 (35%) had post-lumpectomy RT, 2020 (39%) had mastectomy alone, and 913 (18%) had post-mastectomy RT (PMRT). Most patients underwent chemotherapy (79%), and mastectomy was the most common surgical approach (56%). RT delivery was impacted by many factors, including higher nodal disease (p < 0.001), but not T classification or estrogen receptor status (p > 0.05 for both). Post-lumpectomy RT was associated with higher OS in both the pT1–2N0 and pT3–4/N+ subsets (p < 0.001 for both), while PMRT was associated with OS benefits in pT3–4/N+ cases (p < 0.001), but not in pT1–2N0 cases (p = 0.259).

Conclusions

In the largest study to date evaluating MBC, practice patterns of surgery, systemic therapy, and RT are described. The addition of RT in the post-lumpectomy setting was associated with higher OS, in addition to pT3–4/N+ in the post-mastectomy setting. Although not implying causation, further work is required to corroborate the conclusions herein.

Notes

Acknowledgement

The authors have no acknowledgements to report.

Disclosures

Waqar Haque, Vivek Verma, Nilan Naik, E. Brian Butler, and Bin S. Teh declare that no conflicts of interest exist.

Declaration

This work has not been previously presented/published elsewhere in any form.

Funding

No research support was provided for this study.

Supplementary material

10434_2017_6316_MOESM1_ESM.pptx (191 kb)
Kaplan-Meier curve comparing overall survival with and without radiation therapy for women age < 50 years with T2N0 disease undergoing mastectomy. Supplementary material 1 (PPTX 190 kb)
10434_2017_6316_MOESM2_ESM.docx (29 kb)
Supplementary material 2 (DOCX 29 kb)
10434_2017_6316_MOESM3_ESM.docx (119 kb)
Supplementary material 3 (DOCX 118 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research InstituteWeill Cornell Medical CollegeHoustonUSA
  2. 2.Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Department of Radiation OncologyUniversity of Texas Medical BranchGalvestonUSA

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