Abstract
Prognostic factors specific to medullary carcinoma of the breast (MCB) are unknown. Our objective was to identify patient and tumor factors predictive of overall survival (OS) in a large cohort of MCB patients. The Surveillance, Epidemiology, and End Results database was used to identify patients with MCB diagnosed from 1988 to 2004. Patient, tumor, and treatment factors were compared by univariate analysis via the Kaplan–Meier method and survival differences detected using the log-rank test. A multivariate Cox proportional hazards model controlled for patient age, race, type of surgery, radiotherapy, tumor size, number of lymph node metastases (LNM), lymph node yield (LNY), estrogen receptor (ER) and progesterone receptor (PR) status, and extent of disease. On univariate analysis of 3,348 patients, factors influencing OS included age, race, tumor size, ER status, type of surgery, radiotherapy, LNM, LNY, and extent of disease (P < 0.001). On multivariate analysis, advancing age (P < 0.001), black race (P < 0.001), regional metastases (P < 0.001), distant metastases (P < 0.001), increasing tumor size (P < 0.001), ER positivity (P = 0.003), and increasing LNM (P < 0.001) were associated with decreased OS. An OS benefit was seen in PR-positive patients (P = 0.002) and in those with increasing LNY (P < 0.001). Even among node-negative patients, increasing LNY was associated with improved OS (P < 0.001). Tumor size, LNM, regional and distant metastases, PR status, age, and race are important prognostic factors in MCB. ER positivity was associated with decreased OS, which may reflect inaccuracy in diagnosing MCB or a significant biologic variant. The improved OS seen with increasing LNY in node-negative patients suggests MCB may be currently understaged.
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References
Ridolfi RL, Rosen PP, Port A, Kinne D, Mike V. Medullary carcinoma of the breast: a clinicopathologic study with 10 year follow-up. Cancer. 1977;40(4):1365–85.
Bloom HJ, Richardson WW, Field JR. Host resistance and survival in carcinoma of breast: a study of 104 cases of medullary carcinoma in a series of 1, 411 cases of breast cancer followed for 20 years. Br Med J. 1970;3(5716):181–8.
Rapin V, Contesso G, Mouriesse H, Bertin F, Lacombe MJ, Piekarski JD, Travagli JP, Gadenne C, Friedman S. Medullary breast carcinoma. A reevaluation of 95 cases of breast cancer with inflammatory stroma. Cancer. 1988;61(12):2503–10.
Vu-Nishino H, Tavassoli FA, Ahrens WA, Haffty BG. Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT). Int J Radiat Oncol Biol Phys. 2005;62(4):1040–7.
Beal SH, Martinez SR, Canter RJ, Chen SL, Khatri VP, Bold RJ. Survival in 12,653 breast cancer patients with extensive axillary lymph node metastasis in the anthracycline era. Med Oncol. [Epub ahead of print]. doi:10.1007/s12032-009-9396-4.
Chen SL, Martinez SR. The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg. 2008;196(4):495–9.
Webster LR, Lee SF, Ringland C, Morey AL, Hanby AM, Morgan G, Byth K, Mote PA, Provan PJ, Ellis IO, et al. Poor-prognosis estrogen receptor-positive breast cancer identified by histopathologic subclassification. Clin Cancer Res. 2008;14(20):6625–33.
Black CL, Morris DM, Goldman LI, McDonald JC. The significance of lymph node involvement in patients with medullary carcinoma of the breast. Surg Gynecol Obstet. 1983;157(6):497–9.
Fisher ER, Kenny JP, Sass R, Dimitrov NV, Siderits RH, Fisher B. Medullary cancer of the breast revisited. Breast Cancer Res Treat. 1990;16(3):215–29.
Reinfuss M, Stelmach A, Mitus J, Rys J, Duda K. Typical medullary carcinoma of the breast: a clinical and pathological analysis of 52 cases. J Surg Oncol. 1995;60(2):89–94.
Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, Dolan NC, Paskett ED, McTiernan A, Hubbell FA, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005;97(6):439–48.
Henson DE, Chu KC. Levine PH: histologic grade, stage, and survival in breast carcinoma: comparison of African American and Caucasian women. Cancer. 2003;98(5):908–17.
Newman LA, Mason J, Cote D, Vin Y, Carolin K, Bouwman D. Colditz GA: African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10, 000 African-American and 40, 000 White American patients with carcinoma of the breast. Cancer. 2002;94(11):2844–54.
Ponsky JL, Gliga L, Reynolds S. Medullary carcinoma of the breast: an association with negative hormonal receptors. J Surg Oncol. 1984;25(2):76–8.
Silfversward C, Gustafsson JA, Gustafsson SA, Humla S, Nordenskjold B, Wallgren A, Wrange O. Estrogen receptor concentrations in 269 cases of histologically classified human breast cancer. Cancer. 1980;45(8):2001–5.
Vo T, Xing Y, Meric-Bernstam F, Mirza N, Vlastos G, Symmans WF, Perkins GH, Buchholz TA, Babiera GV, Kuerer HM, et al. Long-term outcomes in patients with mucinous, medullary, tubular, and invasive ductal carcinomas after lumpectomy. Am J Surg. 2007;194(4):527–31.
Bertucci F, Finetti P, Cervera N, Charafe-Jauffret E, Mamessier E, Adelaide J, Debono S, Houvenaeghel G, Maraninchi D, Viens P, et al. Gene expression profiling shows medullary breast cancer is a subgroup of basal breast cancers. Cancer Res. 2006;66(9):4636–44.
Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98(19):10869–74.
Oh DS, Troester MA, Usary J, Hu Z, He X, Fan C, Wu J, Carey LA, Perou CM. Estrogen-regulated genes predict survival in hormone receptor-positive breast cancers. J Clin Oncol. 2006;24(11):1656–64.
Pinto AE, Andre S, Pereira T, Nobrega S, Soares J. C-erbB-2 oncoprotein overexpression identifies a subgroup of estrogen receptor positive (ER+) breast cancer patients with poor prognosis. Ann Oncol. 2001;12(4):525–33.
Pedersen L, Holck S, Schiodt T, Zedeler K, Mouridsen HT. Inter- and intraobserver variability in the histopathological diagnosis of medullary carcinoma of the breast, and its prognostic implications. Breast Cancer Res Treat. 1989;14(1):91–9.
Gaffey MJ, Mills SE, Frierson HF Jr, Zarbo RJ, Boyd JC, Simpson JF, Weiss LM. Medullary carcinoma of the breast: interobserver variability in histopathologic diagnosis. Mod Pathol. 1995;8(1):31–8.
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Supported by Grant Number UL1 RR024146 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NNCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.
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Martinez, S.R., Beal, S.H., Canter, R.J. et al. Medullary carcinoma of the breast: a population-based perspective. Med Oncol 28, 738–744 (2011). https://doi.org/10.1007/s12032-010-9526-z
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DOI: https://doi.org/10.1007/s12032-010-9526-z