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Prognosis and effectiveness of chemotherapy for medullary breast carcinoma

  • Epidemiology
  • Published:
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Abstract

Purpose

We aimed to determine the prognosis and potential benefit of postoperative chemotherapy according to subtype of medullary breast carcinoma (MedBC), a very rare invasive breast cancer.

Methods

A cohort of 1518 female patients with unilateral MedBC and 284,544 invasive ductal carcinoma (IDC) cases were enrolled from the Japanese Breast Cancer Registry. Prognosis of MedBC was compared to IDC among patients with estrogen receptor (ER)-negative and HER2-negative subtype (553 exact-matched patients) and ER-positive and HER2-negative subtype (163 MedBC and 489 IDC patients via Cox regression). Disease free-survival (DFS) and overall survival (OS) were compared between propensity score-matched adjuvant chemotherapy users and non-users with ER-negative and HER2-negative MedBC.

Results

Among ER-negative and HER2-negative subtype patients, DFS (hazard ratio (HR) 0.45; 95% confidence interval (95% CI), 0.30–0.68; log-rank P < 0.001) and OS (HR 0.51; 95% CI 0.32–0.83; log-rank P = 0.004) were significantly better in MedBC than IDC. Patients treated with postoperative chemotherapy showed better DFS (HR 0.27; 95% CI 0.09–0.80; log-rank P = 0.02) and OS (HR 0.27; 95% CI 0.09–0.80; log-rank P = 0.02) compared to those without. For the ER-positive and HER2-negative subtype, the point estimate for HR for DFS was 0.60 (95% CI 0.24–1.22) while that for OS was 0.98 (95% CI 0.46–1.84) for MedBC.

Conclusion

In ER-negative and HER2-negative MedBC, the risk of recurrence and death was significantly lower than that of IDC, about half. Postoperative chemotherapy reduced recurrence and mortality. ER-positive and HER2-negative MedBC may have a lower risk of recurrence compared to IDC.

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Acknowledgements

We thank the affiliated institutes participating in the Japanese Breast Cancer Registry of the JBCS for their efforts to register patients’ data. We thank the Japanese Breast Cancer Society for their grant support to perform the present study.

Funding

This work was supported by the Japanese Breast Cancer Society.

Author information

Authors and Affiliations

  1. Breast Center, Aihara Hospital, 3-4-30, Makiochi, Minoh, Osaka, 562-0004, Japan

    Tomohiko Aihara

  2. Department of Healthcare Quality Assessment, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Hiraku Kumamaru & Hiroaki Miyata

  3. Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Makoto Ishitobi

  4. Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan

    Minoru Miyashita

  5. Department of Medical Oncology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan

    Kenji Tamura

  6. Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan

    Masayuki Yoshida

  7. Department of Radiology, Kurume University School of Medicine, 67 Asahisahi-Machi, Kurume, Fukuoka, 830-0011, Japan

    Etsuyo Ogo

  8. Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan

    Masayuki Nagahashi

  9. Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Sota Asaga & Shigeru Imoto

  10. Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yasuyuki Kojima

  11. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan

    Takayuki Kadoya

  12. Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Ko, Minamiumemoto-Machi, Matsuyama, Ehime, 791-0280, Japan

    Kenjiro Aogi

  13. Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Naoki Niikura

  14. Department of Breast Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan

    Kotaro Iijima

  15. Department of Breast Surgical Oncology, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan

    Naoki Hayashi

  16. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan

    Makoto Kubo

  17. Department of Breast and Endocrine Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto-Shi, Kumamoto, 860-8556, Japan

    Yutaka Yamamoto

  18. Division of Medical Statistics, Department of Social Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-Ku, Tokyo, 143-8540, Japan

    Yoshinori Takeuchi

  19. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan

    Hiromitsu Jinno

Authors
  1. Tomohiko Aihara
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  2. Hiraku Kumamaru
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  3. Makoto Ishitobi
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  4. Minoru Miyashita
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  5. Hiroaki Miyata
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  6. Kenji Tamura
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  7. Masayuki Yoshida
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  8. Etsuyo Ogo
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  9. Masayuki Nagahashi
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  10. Sota Asaga
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  11. Yasuyuki Kojima
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  12. Takayuki Kadoya
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  13. Kenjiro Aogi
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  14. Naoki Niikura
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  15. Kotaro Iijima
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  16. Naoki Hayashi
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  17. Makoto Kubo
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  18. Yutaka Yamamoto
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  19. Yoshinori Takeuchi
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  20. Shigeru Imoto
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  21. Hiromitsu Jinno
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Contributions

The study was designed by TA, HK, MI, and MM. All data were analyzed by HK, HM, YT and interpreted by all authors. SI and HJ contributed to funding acquisition and supervision. TA, MI, and MM drafted the manuscript. All authors listed, critically reviewed, and approved the manuscript before submission.

Corresponding author

Correspondence to Tomohiko Aihara.

Ethics declarations

Conflict of interest

HK reports receiving speaker fees from Chugai Pharmaceutical Co., Ltd and Johnson and Johnson KK, and consultation fees from Mitsubishi Tanabe Pharma and EP Croit Co., Ltd. HK is affiliated with the department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by National Clinical Database, Johnson and Johnson KK, Nipro corporation and Intuitive Sàrl. YT reports receiving consultant fees from Pharmaceuticals and Medical Devices Agency and EPARK, Inc., and lecture fees from SAS Institute Japan Ltd. YT and HK are conducting a collaborative study with Pfizer inc., which is not related to the topic of this study.

Ethical approval

This is a database study. The use of the data for retrospective observational studies was approved by the ethics committee of National Clinical Database, and the Ethics Review Committee at the JBCS approved the study.

Enquiries about data availability should be directed to the corresponding author.

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Aihara, T., Kumamaru, H., Ishitobi, M. et al. Prognosis and effectiveness of chemotherapy for medullary breast carcinoma. Breast Cancer Res Treat 196, 635–645 (2022). https://doi.org/10.1007/s10549-022-06749-3

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