Biological subtype, treatment response and outcomes in inflammatory breast cancer using data from the National Cancer Database
Biological subtype, treatment response and outcomes in inflammatory breast cancer using data from the National Cancer Database
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DOI：
10.1002/bjs.11469
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发表时间：
2020-02-14
影响因子：
9.6
通讯作者：
Hieken, T. J.
中科院分区：
文献类型：
--
作者：
Kupstas, A. R.;Hoskin, T. L.;Hieken, T. J.
Background Although inflammatory breast cancer (IBC) is postulated to be a distinct biological entity, practice guidelines and previous data suggest that treatment and outcomes are influenced by standard approximated biological subtype. The aim of this study was validation in a large recent National Cancer Database (NCDB) patient cohort.Methods Patients with non-metastatic IBC treated in 2010-2015 with neoadjuvant systemic therapy and surgery were identified from the NCDB. Approximated biological subtypes were categorized as oestrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-), ER-/HER2- and HER2+. Total pathological complete response (pCR) was defined as ypT0/ypTis, ypN0. chi(2) tests were used to compare pCR rates, and Kaplan-Meier curves and Cox proportional hazards regression to analyse overall survival.Results Among 4068 patients with IBC (median age 56 years), the approximated biological subtype was ER+/HER2- in 1575 (38 center dot 7 per cent), HER2+ in 1323 (32 center dot 5 per cent) and ER-/HER2- in 1170 (28 center dot 8 per cent). A total of 3351 patients (84 center dot 0 per cent) were cN+ at presentation, with no differences across subtypes. Total pCR rates varied significantly by subtype: ER+/HER2- (6 center dot 2 per cent), HER2+ (38 center dot 8 per cent), ER-/HER2- (19 center dot 1 per cent) (P < 0 center dot 001), as did breast pCR rates (10 center dot 4, 44 center dot 5 and 25 center dot 2 per cent respectively) and nodal pCR rates (16 center dot 9, 56 center dot 9 and 33 center dot 1 per cent). The 5-year overall survival rate varied significantly across subtypes (ER+/HER2- 64 center dot 9 per cent, HER2+ 74 center dot 0 per cent, ER-/HER2- 44 center dot 0 per cent; P < 0 center dot 001) and by pCR within subtypes (all P < 0 center dot 001). In multivariable analysis, ER-/HER2- subtype (hazard ratio 2 center dot 89 versus HER2+ as reference; P < 0 center dot 001) and absence of total pCR (hazard ratio 3 center dot 23; P < 0 center dot 001) predicted worse survival.Conclusion Both treatment response and survival in patients with IBC varied with approximated biological subtype, as among other invasive breast cancers. These data support continued tailoring of systemic treatment to approximated biological subtype and highlight the recent improved outcomes in patients with HER2+ disease.
