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The Role of Mastectomy in De Novo Stage IV Inflammatory Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript



The role of modified radical mastectomy (MRM) in patients with de novo stage IV inflammatory breast cancer (IBC) remains controversial. We evaluated the impact of MRM on outcomes in this population.


Ninety-seven women presenting with stage IV IBC were identified in an institutional database (2007–2016) and were stratified by receipt of MRM or no surgery (non-MRM). Demographic, clinicopathologic, and treatment factors were compared. Local–regional recurrence patterns were described and survival analyses were conducted.


All patients initially received chemotherapy. Fifty-two patients (53.6%) underwent MRM; 47 received post-mastectomy radiation. Differences between the non-MRM and MRM groups included tumor receptor subtypes (hormone receptor-positive [HR+]/human epidermal growth factor receptor 2-positive [HER2+]: 4.4% vs. 19.2%; HR+/HER2-negative [HER2−]: 31.1% vs. 44.2%; HR-negative [HR−]/HER2+: 24.4% vs. 15.4%; and HR−/HER2−: 40.0% vs. 21.2%; p = 0.03), number of metastatic sites (3 vs. 2; p = 0.01), and clinical partial/complete response to chemotherapy (13.3% vs. 75.0%; p < 0.001). Of the 47 patients who completed trimodality therapy, 6 (12.8%) had a local–regional recurrence. Median overall survival (OS) was 19 months in the non-MRM group and 58 months in the MRM group (p < 0.001). On multivariable analysis, clinical N3 disease (hazard ratio 2.16, 95% confidence interval [CI] 1.07–4.37; p = 0.03) as well as tumor subtypes HR+/HER2− (hazard ratio 4.98, 95% CI 1.15–21.47; p = 0.03) and HR−/HER2− (hazard ratio 7.18, 95% CI 1.66–31.07; p = 0.008) were associated with decreased OS. Partial/complete response of distant disease to chemotherapy (hazard ratio 0.43, 95% CI 0.24–0.77; p = 0.005) and receipt of MRM (hazard ratio 0.52, 95% CI 0.29–0.93; p = 0.03) were independently associated with improved OS.


In our retrospective study, MRM in de novo stage IV IBC patients is an independent factor associated with improved OS. Our findings strongly support the need for prospective randomized trials evaluating possible survival benefits of MRM in de novo stage IV IBC patients.

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  1. Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH. Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 2005;97(13):966–75.

    Article  Google Scholar 

  2. Matro JM, Li T, Cristofanilli M, et al. Inflammatory breast cancer management in the national comprehensive cancer network: the disease, recurrence pattern, and outcome. Clin Breast Cancer. 2015;15(1):1–7.

    Article  Google Scholar 

  3. Wingo PA, Jamison PM, Young JL, Gargiullo P. Population-based statistics for women diagnosed with inflammatory breast cancer (United States). Cancer Causes Control. 2004;15(3):321–8.

    Article  Google Scholar 

  4. Rosso KJ, Tadros AB, Weiss A, et al. Improved locoregional control in a contemporary cohort of nonmetastatic inflammatory breast cancer patients undergoing surgery. Ann Surg Oncol. 2017;24(10):2981–8.

    Article  Google Scholar 

  5. Warren LE, Guo H, Regan MM, et al. Inflammatory breast cancer: patterns of failure and the case for aggressive locoregional management. Ann Surg Oncol. 2015;22(8):2483–91.

    Article  Google Scholar 

  6. Soran A, Ozmen V, Ozbas S, et al. Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: protocol MF07-01. Ann Surg Oncol. 2018;25(11):3141–9.

    Article  Google Scholar 

  7. Badwe R, Hawaldar R, Nair N, et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol. 2015;16(13):1380–8.

    Article  Google Scholar 

  8. Khan SA, Zhao F, Solin LJ, Goldstein LJ, Cella D, Basik M, et al. A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: a trial of the ECOG-ACRIN Research Group (E2108). J Clin Oncol. 2020;38(18):LBA2.

    Article  Google Scholar 

  9. Akay CL, Ueno NT, Chisholm GB, et al. Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage IV inflammatory breast cancer. Cancer. 2014;120(9):1319–28.

    Article  Google Scholar 

  10. Ueno NT, Espinosa Fernandez JR, Cristofanilli M, et al. International consensus on the clinical management of inflammatory breast cancer from the morgan welch inflammatory breast cancer research program 10th anniversary conference. J Cancer. 2018;9(8):1437–47.

    Article  Google Scholar 

  11. Tsai CJ, Li J, Gonzalez-Angulo AM, et al. Outcomes after multidisciplinary treatment of inflammatory breast cancer in the era of neoadjuvant HER2-directed Therapy. Am J Clin Oncol. 2015;38(3):242–7.

    Article  CAS  Google Scholar 

  12. Dawood S, Gong Y, Broglio K, et al. Trastuzumab in primary inflammatory breast cancer (IBC): high pathological response rates and improved outcome. Breast J. 2010;16(5):529–32.

    Article  CAS  Google Scholar 

  13. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. (8th Ed). Springer, New York, 2017.

    Book  Google Scholar 

  14. van Uden DJP, van Maaren MC, Strobbe LJA, et al. Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer. Surg Oncol. 2020;33:43–50.

    Article  Google Scholar 

  15. Weiss A, Menen RS, Lin HY, et al. Factors associated with improved outcomes for metastatic inflammatory breast cancer patients. Breast Cancer Res Treat. 2018;169(3):615–23.

    Article  Google Scholar 

  16. Takiar V, Akay CL, Stauder MC, et al. Predictors of durable no evidence of disease status in de novo metastatic inflammatory breast cancer patients treated with neoadjuvant chemotherapy and post-mastectomy radiation. SpringerPlus. 2014;3:166.

    Article  Google Scholar 

  17. Dawood S, Ueno NT, Valero V, et al. Identifying factors that impact survival among women with inflammatory breast cancer. Ann Oncol. 2012;23(4):870–5.

    Article  CAS  Google Scholar 

  18. Li J, Gonzalez-Angulo AM, Allen PK, et al. Triple-negative subtype predicts poor overall survival and high locoregional relapse in inflammatory breast cancer. Oncologist. 2011;16(12):1675–83.

    Article  CAS  Google Scholar 

  19. King TA, Lyman JP, Gonen M, et al. Prognostic impact of 21-gene recurrence score in patients with stage IV breast cancer: TBCRC 013. J Clin Oncol. 2016;34(20):2359–65.

    Article  CAS  Google Scholar 

  20. Hamm CA, Moran D, Rao K, et al. Genomic and immunological tumor profiling identifies targetable pathways and extensive CD8+/PDL1+ immune infiltration in inflammatory breast cancer tumors. Mol Cancer Ther. 2016;15(7):1746–56.

    Article  CAS  Google Scholar 

  21. Liang X, Vacher S, Boulai A, et al. Targeted next-generation sequencing identifies clinically relevant somatic mutations in a large cohort of inflammatory breast cancer. Breast Cancer Res. 2018;20(1):88.

    Article  Google Scholar 

  22. Ross JS, Ali SM, Wang K, et al. Comprehensive genomic profiling of inflammatory breast cancer cases reveals a high frequency of clinically relevant genomic alterations. Breast Cancer Res Treat. 2015;154(1):155–62.

    Article  CAS  Google Scholar 

  23. Bertucci F, Finetti P, Vermeulen P, et al. Genomic profiling of inflammatory breast cancer: a review. Breast. 2014;23(5):538–45.

    Article  Google Scholar 

  24. Lim B, Woodward WA, Wang X, Reuben JM, Ueno NT. Inflammatory breast cancer biology: the tumour microenvironment is key. Nat Rev Cancer. 2018;18(8):485–99.

    Article  CAS  Google Scholar 

  25. Provance OK, Lewis-Wambi J. Deciphering the role of interferon alpha signaling and microenvironment crosstalk in inflammatory breast cancer. Breast Cancer Res. 2019;21(1):59.

    Article  Google Scholar 

  26. Reddy SM, Reuben A, Barua S, et al. Poor response to neoadjuvant chemotherapy correlates with mast cell infiltration in inflammatory breast cancer. Cancer Immunol Res. 2019;7(6):1025–35.

    Article  CAS  Google Scholar 

  27. Van Laere SJ, Ueno NT, Finetti P, et al. Uncovering the molecular secrets of inflammatory breast cancer biology: an integrated analysis of three distinct affymetrix gene expression datasets. Clin Cancer Res. 2013;19(17):4685–96.

    Article  Google Scholar 

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Correspondence to Anthony Lucci MD, FACS.

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Natalia Partain, Lauren M. Postlewait, Mediget Teshome, Kelly Rosso, Carolyn Hall, Juhee Song, Salyna Meas, Sarah M. DeSnyder, Bora Lim, Vicente Valero, Wendy Woodward, Naoto T. Ueno, Henry Kuerer, and Anthony Lucci have no disclosures to declare.

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Partain, N., Postlewait, L.M., Teshome, M. et al. The Role of Mastectomy in De Novo Stage IV Inflammatory Breast Cancer. Ann Surg Oncol 28, 4265–4274 (2021).

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