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Barrientos-Toro EN, Ding Q, Raso MG. Translational Aspects in Metaplastic Breast Carcinoma. Cancers (Basel) 2024; 16:1433. [PMID: 38611109 PMCID: PMC11011105 DOI: 10.3390/cancers16071433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer is the most common cancer among women. Metaplastic breast carcinoma (MpBC) is a rare, heterogeneous group of invasive breast carcinomas, which are classified as predominantly triple-negative breast carcinomas (TNBCs; HR-negative/HER2-negative). Histologically, MpBC is classified into six subtypes. Two of these are considered low-grade and the others are high-grade. MpBCs seem to be more aggressive, less responsive to neoadjuvant chemotherapy, and have higher rates of chemoresistance than other TNBCs. MpBCs have a lower survival rate than expected for TNBCs. MpBC treatment represents a challenge, leading to a thorough exploration of the tumor immune microenvironment, which has recently opened the possibility of new therapeutic strategies. The epithelial-mesenchymal transition in MpBC is characterized by the loss of intercellular adhesion, downregulation of epithelial markers, underexpression of genes with biological epithelial functions, upregulation of mesenchymal markers, overexpression of genes with biological mesenchymal functions, acquisition of fibroblast-like (spindle) morphology, cytoskeleton reorganization, increased motility, invasiveness, and metastatic capabilities. This article reviews and summarizes the current knowledge and translational aspects of MpBC.
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Affiliation(s)
- Elizve Nairoby Barrientos-Toro
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Gabriela Raso
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Tan Y, Yang B, Chen Y, Yan X. Outcomes of Metaplastic Breast Cancer Versus Triple-Negative Breast Cancer: A Propensity Score Matching Analysis. World J Surg 2023; 47:3192-3202. [PMID: 37709983 DOI: 10.1007/s00268-023-07106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE This study aims to compare the survival outcomes of metaplastic breast cancer (MPBC) with triple-negative breast cancer (TNBC) and identify prognostic factors that influence the survival outcomes of MPBC patients and TNBC patients. METHODS Patients with nonmetastatic MPBC or TNBC were reviewed from our database. Patients' clinicopathologic and molecular features were analyzed with respect to outcomes, including disease-free survival (DFS) and overall survival (OS). Propensity score matching (PSM) with a one-to-three matching between MPBC patients and TNBC patients was performed. RESULTS A total of 857 female patients (76 MPBC patients and 781 TNBC patients) were included in this study. A subgroup of triple-negative MPBC (n = 60) was matched with TNBC (n = 180) cases based on patient characteristics and treatments. Kaplan-Meier analysis indicated that the MPBC group was associated with worse OS and DFS before (P = 0.0046 both) and after (P = 0.011 and P = 0.0046, respectively) PSM. Multivariable analysis revealed that a higher T stage (T > 2) (P = 0.032) and higher lymph node stage (N3 vs. N0-2, P = 0.012) were associated with worse OS after PSM. For DFS, the MPBC group (P = 0.012), higher T stage (T > 2) (P = 0.032), and higher lymph node stage (N3 vs. N0-2, P = 0.045) were associated with worse DFS. Among the 76 MPBC patients, a higher T stage and mesenchymal differentiation were associated with worse OS (pT1/2 vs. pT3/4 and mesenchymal differentiation vs. other subtypes, P = 0.007 and P = 0.011, respectively). CONCLUSIONS Compared with TNBC, MPBC was associated with worse OS and DFS. Mesenchymal differentiation has a worse DFS than other subtypes of MPBC.
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Affiliation(s)
- YuPing Tan
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine University, Chengdu, People's Republic of China
| | - Biao Yang
- Department of Gastroenterology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - YuHong Chen
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Yan
- Cancer Center, Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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McMurtry V, Cleary AS, Ruano AL, Lomo L, Gulbahce HE. Metaplastic Breast Carcinoma: Clinicopathologic Features and Recurrence Score Results From a Population-based Database. Am J Clin Oncol 2023; 46:559-566. [PMID: 37705411 DOI: 10.1097/coc.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Metaplastic breast carcinoma (MBC) is a rare, aggressive form of cancer comprising epithelial and mesenchymal elements. The purpose of this study was to use population-based data to review the clinicopathologic, molecular features, and outcomes of MBC. METHODS Surveillance, Epidemiology, and End Results Program (SEER) data were used to identify MBC and invasive ductal carcinoma (IDC), no special type (NOS) between 2004 and 2015. Results from Oncotype DX's 21-gene assay linked to SEER registries were included for hormone receptor (HR)-positive tumors. χ 2 analysis was performed to determine the differences between MBC and IDC. Kaplan-Meier curves and multivariate Cox proportional hazards models were used for breast cancer specific death (BCSD). RESULTS Compared with IDC, NOS (n=509,864), MBC (n=3876) were more likely to present at an older age, be black, have negative lymph nodes, be >2 cm, grade 3, and triple negative (TN). All subtypes [HR-positive/human epidermal growth receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and TN] had higher BCSD than IDC, NOS. 22.3% of MBC cases were HR-positive. HR-positive MBCs tested for a recurrence score (RS) 65% were high-risk compared with 16.8% of IDC, NOS. Within the MBC cohort, no significant differences in BCSD were identified with respect to different molecular subtypes. In a fully adjusted model, TN or HER2-positive status did not adversely affect BCSD compared with HR-positive MBC. CONCLUSIONS All molecular subtypes of MBC had a poorer prognosis compared with IDC, NOS. The different molecular subtypes of MBC did not affect the BCSD. HR-positive MBC patients had a significantly higher high-risk RS than IDC, NOS patients.
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Affiliation(s)
- Valarie McMurtry
- Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute University of Utah Health, Salt Lake City, UT
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Thomas HR, Hu B, Boyraz B, Johnson A, Bossuyt VI, Spring L, Jimenez RB. Metaplastic breast cancer: A review. Crit Rev Oncol Hematol 2023; 182:103924. [PMID: 36696934 DOI: 10.1016/j.critrevonc.2023.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/19/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Metaplastic breast cancer (MpBC) is an uncommon aggressive malignancy that is associated with a poor prognosis. Due to its rarity, the relationships between the clinical and pathological features of MpBC, treatment approach, and clinical outcomes remain underexplored. In the following review article, we synthesize the existing data on the clinical, pathological and genomic features, management, and outcomes of MpBC. We also identify potential targets for future clinical trials.
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Affiliation(s)
- Horatio R Thomas
- Department of Radiation Oncology, University of California, San Francisco, United States.
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, United States
| | - Baris Boyraz
- Department of Pathology, Massachusetts General Hospital, United States
| | - Andrew Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, United States
| | - Veerle I Bossuyt
- Department of Pathology, Massachusetts General Hospital, United States
| | - Laura Spring
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, United States
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, United States
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Corso G, D'Ecclesiis O, Magnoni F, Mazzotta E, Conforti F, Veronesi P, Sajjadi E, Venetis K, Fusco N, Gandini S. Metaplastic breast cancers and triple-negative breast cancers of no special type: are they prognostically different? A systematic review and meta-analysis. Eur J Cancer Prev 2022; 31:459-466. [PMID: 35088973 DOI: 10.1097/cej.0000000000000733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Metaplastic breast cancer (MBC) and triple-negative (TN) BC of no special type are often confounded with each other in terms of survival and prognosis. In this systematic study and meta-analysis, we evaluated the prognosis of each of these two different diagnoses. METHODS We conducted a systematic literature search and review using the MOOSE guidelines, through PUBMED database, the Ovid MEDLINE database, and the ISI Web of Science Citation Index Expanded (SCI Expanded). Overall survival (OS) and disease-free survival (DFS) were the main outcomes considered. RESULTS Our review eventually selected six independent studies, with a total of more than 59 519 patients. MBC was found to associate with worse OS compared to TNBC of no special type, with a significant 40% increased risk of death [summary hazard ratio (SHR) = 1.40, 95% confidence interval (CI): 1.30-1.50]. We found neither heterogeneity ( I2 = 0%) nor evidence of publication bias ( P = 0.82 and P = 0.49 by Begg's and Egger's test, respectively) between studies. No statistically significant difference was found between MBC and TNBC of no special type in terms of DFS (SHR = 1.17, 95% CI: 0.80-1.71). CONCLUSION This study demonstrates that TNBC of no special type and MBC have comparable DFS, although the latter presents a significantly worse prognosis in terms of OS. Despite DFS being similar in both subtypes, this did not result in significant OS benefits, with MBC score being the worse of the two diseases.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - Oriana D'Ecclesiis
- Division of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
| | - Erica Mazzotta
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
| | - Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology (IEO), IRCCS, Milan
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Konstantinos Venetis
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Sara Gandini
- Division of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan
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Thapa B, Arobelidze S, Clark BA, Xuefei J, Daw H, Cheng YC, Patel M, Spiro TPP, Haddad A. Metaplastic Breast Cancer: Characteristics and Survival Outcomes. Cureus 2022; 14:e28551. [PMID: 36185859 PMCID: PMC9517584 DOI: 10.7759/cureus.28551] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Metaplastic breast cancer (MBC) is a rare neoplasm accounting for <1% of all breast cancer. We evaluated the clinical characteristics and survival outcomes of MBC. Methods Patients diagnosed with pathologically proven MBC were reviewed from the institutional breast cancer database from 2000 to 2017. Results A total of 136 patients diagnosed with MBC were included in the study. The median age of the diagnosis was 60 years, and 60% of patients were stage II at diagnosis, and 22% were stage III. About two-thirds of the patients were triple-negative; 93% had nuclear grade III, and 25% had a lymphovascular invasion. Squamous differentiation (29%) was the most common histologic subtype, followed by the spindle subtype (21%). The most common distant metastases were lung (22%), followed by bone (13%). Moreover, 60% had a mastectomy, 19% had endocrine therapy, 58% had radiation, 51% received anthracycline-based chemotherapy, 26% had non-anthracycline chemotherapy, and 22% received no chemotherapy. In the entire cohort, the two-year overall survival (OS) and five-year OS were 79% and 69%, respectively, and the two-year progression-free survival (PFS) and five-year PFS were 72% and 61%, respectively. On multivariable analysis, the stage of MBC (stage III: hazard ratio (HR), 5.065 (95% confidence interval (CI), 1.02-25.27) (p=0.048)), poor functional status (Eastern Cooperative Oncology Group (ECOG) score, 2; HR, 24.736 (95% CI, 1.92-318.73) (p=0.014)), and distant metastasis to the brain (HR, 8.453 (95% CI, 1.88-38.04) (p=0.005)) and lung (HR, 42.102 (95% CI, 7.20-246.36) (p<0.001)) were significant predictors of decreased OS. Conclusions MBC demonstrated early disease progression and poor overall survival. The stage of MBC, decreased performance status, and metastasis to the lung and brain were independent poor prognostic factors.
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González-Martínez S, Pérez-Mies B, Pizarro D, Caniego-Casas T, Cortés J, Palacios J. Epithelial Mesenchymal Transition and Immune Response in Metaplastic Breast Carcinoma. Int J Mol Sci 2021; 22:ijms22147398. [PMID: 34299016 PMCID: PMC8306902 DOI: 10.3390/ijms22147398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Metaplastic breast carcinoma (MBC) is a heterogeneous group of infrequent triple negative (TN) invasive carcinomas with poor prognosis. MBCs have a different clinical behavior from other types of triple negative breast cancer (TNBC), being more resistant to standard chemotherapy. MBCs are an example of tumors with activation of epithelial–mesenchymal transition (EMT). The mechanisms involved in EMT could be responsible for the increase in the infiltrative and metastatic capacity of MBCs and resistance to treatments. In addition, a relationship between EMT and the immune response has been seen in these tumors. In this sense, MBC differ from other TN tumors showing a lower number of tumor-infiltrating lymphocytes (TILS) and a higher percentage of tumor cells expressing programmed death-ligand 1 (PD-L1). A better understanding of the relationship between the immune system and EMT could provide new therapeutic approaches in MBC.
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Affiliation(s)
| | - Belén Pérez-Mies
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
| | - David Pizarro
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
| | - Tamara Caniego-Casas
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
| | - Javier Cortés
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, 28670 Madrid, Spain
- International Breast Cancer Center (IBCC), Quironsalud Group, 08017 Barcelona, Spain
- Medica Scientia Innovation Research, 08007 Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, NJ 07450, USA
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
- Correspondence: (J.C.); (J.P.)
| | - José Palacios
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence: (J.C.); (J.P.)
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Tadros AB, Sevilimedu V, Plitas G. Reply to: Metaplastic Breast Carcinoma and Other Triple-Negative Subtype Breast Cancers: Which is the Worst? Ann Surg Oncol 2021; 28:5440-5441. [PMID: 33566247 DOI: 10.1245/s10434-021-09679-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Audree B Tadros
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - George Plitas
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Corso G, Frassoni S, Girardi A, De Camilli E, Montagna E, Intra M, Bottiglieri L, Margherita De Scalzi A, Fanianos DM, Magnoni F, Invento A, Toesca A, Conforti F, Bagnardi V, Viale G, Colleoni MA, Veronesi P. Metaplastic breast cancer: Prognostic and therapeutic considerations. J Surg Oncol 2021; 123:61-70. [PMID: 33047318 DOI: 10.1002/jso.26248] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Metaplastic breast cancer (MBC) is a rare condition of breast tumor with different subtypes, considered a disease with worse prognosis; treatments and survival are often unclear and conflicting. METHODS We consecutively collected 153 primary MBCs of different subtypes. Breast surgery, neoadjuvant or adjuvant treatment, clinic-pathological factors, number and type of events during follow-up were considered to evaluate overall survival (OS) and invasive disease-free survival (IDFS). RESULTS The majority of MBC was triple-negative (TN) subtype (88.7%), G3 (95.3%), pN0 (70.6%), and with high levels of Ki-67 (93.5%). For OS and IDFS, no significant associations were seen between the different MBC subtypes. The matched triple-negative MBC (TNMBC) and ductal TNBC cohorts had similar prognosis both in terms of OS (p = .411) and IDFS (p = .981). We observed a positive trend for TNMBC patients treated in the adjuvant setting with the cyclofosfamide, methotrexate, 5-fluorouracil protocol for better OS (p = .090) and IDFS (p = .087). A poor or absent response rate was observed in the neoadjuvant setting. CONCLUSION Our results demonstrate that metaplastic and ductal breast cancers with TN phenotype are similar in terms of overall and disease-free survival. Metaplastic cancers are poorly responsive to neoadjuvant treatment, and in the absence of novel targeted therapies, surgical treatment remains the first choice.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Antonia Girardi
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emilia Montagna
- Division of Breast Cancer Medical Treatments, European Institute of Oncology, IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Luca Bottiglieri
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandra Invento
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Viale
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Angelo Colleoni
- Division of Breast Cancer Medical Treatments, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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The longitudinal risk of mortality between invasive ductal carcinoma and metaplastic breast carcinoma. Sci Rep 2020; 10:22070. [PMID: 33328559 PMCID: PMC7744577 DOI: 10.1038/s41598-020-79166-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
The management of metaplastic breast carcinoma (MBC) has largely paralleled the paradigms used for invasive ductal carcinoma (IDC) in the current National Comprehensive Cancer Network guidelines of breast cancer. However, patients with IDC and MBC have been shown to have a different prognosis, and there are significant differences in risk and failure patterns after treatment. The purpose of this study was to compare breast cancer specific survival (BCSS) and hazard function between IDC and MBC. We included patients from the Surveillance, Epidemiology, and End Results program with stage I-III IDC and MBC between 2000 and 2012. Statistical analyses were including chi-square analysis, life-table methods, multivariate Cox proportional hazards models, and propensity score matching (PSM). We identified 294,719 patients; 293,199 patients with IDC and 1520 patients with MBC. Multivariate analyses showed that the MBC subtype had significantly lower BCSS than the IDC subtype before and after PSM (p < 0.001). There were significant differences in the hazard curve between IDC and MBC. The hazard curve for breast cancer mortality in the IDC cohort peaked at 3 years (2%), and then changed to a slowly decreasing plateau after prolonged follow up. However, the hazard curve for breast cancer mortality in the MBC cohort peaked at 2 years (7%), then declined sharply between 3 and 6 years, and changed to a low death rate after a follow-up time exceeding 6 years. Subgroup analyses revealed that the hazard curves significantly differed between IDC and MBC after stratifying by tumor stage and hormone receptor status. Our study suggests that patients with MBC should receive more effective systemic agents and intensive follow-up because of their significantly augmented risk of death compared to IDC patients.
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González-Martínez S, Pérez-Mies B, Carretero-Barrio I, Palacios-Berraquero ML, Perez-García J, Cortés J, Palacios J. Molecular Features of Metaplastic Breast Carcinoma: An Infrequent Subtype of Triple Negative Breast Carcinoma. Cancers (Basel) 2020; 12:cancers12071832. [PMID: 32650408 PMCID: PMC7408634 DOI: 10.3390/cancers12071832] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022] Open
Abstract
Metaplastic breast carcinoma (MBC) is a heterogeneous group of infrequent invasive carcinomas that display differentiation of the neoplastic epithelium towards squamous cells and/or mesenchymal-type elements. Most MBC have a triple negative phenotype and poor prognosis. Thus, MBC have worse survival rates than other invasive breast carcinomas, including other triple negative breast carcinomas (TNBC). In this study, we reviewed the molecular features of MBC, pointing out the differences among subtypes. The most frequently mutated genes in MBC were TP53 and PIK3CA. Additionally, mutations in the other genes of the PI3K/AKT pathway indicated its importance in the pathogenesis of MBC. Regarding copy number variations (CNVs), MYC was the most frequently amplified gene, and the most frequent gene loss affected the CDKN2A/CDKN2B locus. Furthermore, the pattern of mutations and CNVs of MBC differed from those reported in other TNBC. However, the molecular profile of MBC was not homogeneous among histological subtypes, being the alterations in the PI3K pathway most frequent in spindle cell carcinomas. Transcriptomic studies have demonstrated an epithelial to mesenchymal program activation and the enrichment of stemness genes in most MBC. In addition, current studies are attempting to define the immune microenvironment of these tumors. In conclusion, due to specific molecular features, MBC have a different clinical behavior from other types of TNBC, being more resistant to standard chemotherapy. For this reason, new therapeutic approaches based on tumor molecular characteristics are needed to treat MBC.
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Affiliation(s)
| | - Belén Pérez-Mies
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (B.P.-M.); (I.C.-B.)
- Instituto Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, 28801 Madrid, Spain
| | - Irene Carretero-Barrio
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (B.P.-M.); (I.C.-B.)
| | | | - José Perez-García
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, 08023 Barcelona, Spain;
| | - Javier Cortés
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, 08023 Barcelona, Spain;
- IOB Institute of Oncology, Quironsalud Group, 28006 Madrid, Spain
- Medica Scientia Innovation Research, 08018 Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, NJ 07450, USA
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
- Correspondence: (J.C.); (J.P.)
| | - José Palacios
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (B.P.-M.); (I.C.-B.)
- Instituto Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, 28801 Madrid, Spain
- Correspondence: (J.C.); (J.P.)
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12
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He X, Ji J, Dong R, Liu H, Dai X, Wang C, Esteva FJ, Yeung SCJ. Prognosis in different subtypes of metaplastic breast cancer: a population-based analysis. Breast Cancer Res Treat 2018; 173:329-341. [PMID: 30341462 DOI: 10.1007/s10549-018-5005-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Metaplastic breast cancer (MpBC) is a rare histological subtype of breast cancer recognized as a unique pathologic entity in 2000. However, the pathogenesis, optimal therapy, and prognosis of MpBC and the potential effect of systemic treatments on different subtypes of MpBC are not well defined. METHODS A retrospective population-based study was performed to identify breast cancer patients with MpBC and other triple-negative breast cancers (TNBC) between 2010 and 2014 using the surveillance, Epidemiology, and End Results (SEER) database. Chi-square test was used to analyze characteristics between subgroups. Kaplan-Meier analysis and Multivariate Cox regressions were used to evaluate overall survival (OS) of MpBC, TNBC, and MpBC subgroups. Competing risk analysis and multivariate regression model of competing risk were used to assess breast cancer-specific survival (BCSS) of MpBC and TNBC RESULTS: We identified a study cohort of 22,433 patients (1112 MpBC and 21,321 TNBC). MpBC correlated with older population, larger tumor size and less lymph node involvement, and TNBC phenotype. Patients with MpBC especially with triple-negative subtype (TN-MpBC) had worse survival than the overall TNBC population. However, the prognosis of MpBC without triple-negative subtype (non-TN MpBC) was not different from that of TNBC. In Kaplan-Meier analysis, chemotherapy was not associated with significant difference in OS of TN-MpBC. In non-TN MpBC group, the 3-year OS was 79.8% for patients receiving chemotherapy and 70.5% in patients without chemotherapy, and chemotherapy was associated (P = 0.033) with improved OS. Within the MpBC patients, radiotherapy was significantly (HR 1.544; 95% CI 1.148-2.078; P = 0.004) associated with improved OS and (HR 1.474; 95% CI 1.067-2.040; P = 0.019) BCSS. CONCLUSIONS Patients with TN-MpBC had worse prognosis than TNBC and chemotherapy was not associated with improved survival. In contrast, non-TN MpBC may derive survival benefit from chemotherapy and radiotherapy.
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Affiliation(s)
- Xuexin He
- Department of Medical Oncology, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, Zhejiang, 310010, China. .,Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jiali Ji
- Department of Medical Oncology, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, Zhejiang, 310010, China
| | - Rongrong Dong
- Department of Medical Oncology, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, Zhejiang, 310010, China
| | - Hong Liu
- Department of Medical Oncology, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, Zhejiang, 310010, China
| | - Xiaolan Dai
- Department of Pharmacology, Shantou University, Shantou, Guangdong, China
| | - Chongjian Wang
- Department of Biostatistics, Zhengzhou University, Zhengzhou, Henan, China
| | - Francisco J Esteva
- Division of Hematology/Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Sai-Ching Jim Yeung
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1468, Houston, TX, 77030, USA.
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13
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Ong CT, Campbell BM, Thomas SM, Greenup RA, Plichta JK, Rosenberger LH, Force J, Hall A, Hyslop T, Hwang ES, Fayanju OM. Metaplastic Breast Cancer Treatment and Outcomes in 2500 Patients: A Retrospective Analysis of a National Oncology Database. Ann Surg Oncol 2018; 25:2249-2260. [PMID: 29855830 DOI: 10.1245/s10434-018-6533-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metaplastic breast cancer (MBC) is characterized by chemoresistance and hematogenous spread. We sought to identify factors associated with improved MBC outcomes and increased likelihood of MBC diagnosis. METHODS Women ≥ 18 years of age with stage I-III MBC and non-MBC diagnosed between 2010 and 2014 were identified in the National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional hazards models were used to estimate associations with overall survival (OS). Multivariate logistic regression identified factors associated with MBC diagnosis. RESULTS Overall, 2451 MBC and 568,057 non-MBC patients were included; 70.3% of MBC vs. 11.3% of non-MBC patients were triple negative (p < 0.001). Five-year OS was reduced among MBC vs. non-MBC patients for the entire cohort (72.7 vs. 87.5%) and among triple-negative patients (71.1 vs. 77.8%; both p < 0.001). In MBC, triple-negative (vs. luminal) subtype was not associated with worse OS (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.88-1.54, p = 0.28). Compared with non-MBC patients, MBC patients were more likely to receive mastectomy (59.0 vs. 44.9%), chemotherapy (74.1 vs. 43.1%), and axillary lymph node dissection (ALND; 35.2 vs. 32.2%, all p ≤ 0.001). MBC patients more frequently had negative ALND (pN0) than non-MBC patients (20.0 vs. 10.6%, p < 0.001). Among MBC patients, chemotherapy (HR 0.69, 95% CI 0.53-0.89, p = 0.004) and radiotherapy (HR 0.52, 95% CI 0.39-0.69, p < 0.001) were associated with improved survival, while ALND was associated with decreased survival (HR 1.37, 95% CI 1.06-1.77, p = 0.02). CONCLUSIONS MBC patients had worse survival than non-MBC patients, independent of receptor status, suggesting that MBC may confer an additional survival disadvantage. Multimodal therapy was associated with improved outcomes, but ALND was not and may be overutilized in MBC.
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Affiliation(s)
- Cecilia T Ong
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Jeremy Force
- Duke Cancer Institute, Durham, NC, USA.,Department of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - Allison Hall
- Duke Cancer Institute, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Durham, NC, USA.
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14
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El Zein D, Hughes M, Kumar S, Peng X, Oyasiji T, Jabbour H, Khoury T. Metaplastic Carcinoma of the Breast Is More Aggressive Than Triple-negative Breast Cancer: A Study From a Single Institution and Review of Literature. Clin Breast Cancer 2017; 17:382-391. [PMID: 28529029 DOI: 10.1016/j.clbc.2017.04.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/21/2017] [Accepted: 04/14/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to describe our experience with metaplastic breast carcinoma (MBC), evaluate its clinical outcome compared with triple-negative breast cancer (TNBC), and provide a through and comprehensive review of the literature to date. MATERIALS AND METHODS We reviewed MBC cases (n = 46) from our institution. The following variables were recorded: tumor histologic subtype, Nottingham grade, tumor size, lymph node status, Tumor, Node, Metastases stage, biomarkers profile, patient's age and race, therapy modality (chemotherapy and radiation), and survival (disease-free survival [DFS] and overall survival [OS]). The clinical and pathological data for TNBC (n = 508) cases were extracted from the breast cancer database. To compare the survival between MBC and TNBC, a subgroup of MBC cases (n = 40) were matched with TNBC cases (n = 40) on the basis of known prognostic confounders. RESULTS There were 17 of 46 (37%) cases with mesenchymal differentiation, 12 (26.1%) squamous cell carcinoma, 14 (30.4%) spindle cell carcinoma, and 3 (6.5%) mixed type. MBC presented at a more advanced stage than TNBC (P = .014) and was more likely to recur (34% vs. 15.5%; P = .004). More MBC patients died from disease than TNBC (29% vs. 16%; P = .05). In the multivariate analysis, MBC had approximately twice the risk of local recurrence than TNBC (95% confidence interval, 1.01-3.83; P = .05). MBC patients had worse DFS and OS than the matched TNBC patients (P < .001 and P = .033, respectively). A review of the literature comparing MBC versus TNBC is presented. CONCLUSION Our results suggest that MBC is clinically more aggressive than TNBC. Further studies might help delineate the differences between these 2 entities.
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Affiliation(s)
- Dima El Zein
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Melissa Hughes
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Shicha Kumar
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Xuan Peng
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY
| | - Tolutope Oyasiji
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Hossam Jabbour
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY.
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15
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Edenfield J, Schammel C, Collins J, Schammel D, Edenfield WJ. Metaplastic Breast Cancer: Molecular Typing and Identification of Potential Targeted Therapies at a Single Institution. Clin Breast Cancer 2016; 17:e1-e10. [PMID: 27568101 DOI: 10.1016/j.clbc.2016.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 06/26/2016] [Accepted: 07/18/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Metaplastic breast carcinoma (MBC) is a rare and aggressive histologic subtype of breast cancer comprising approximately 0.5% to 5.0% of all invasive breast cancers with a poor prognosis and limited therapeutic options. PATIENTS AND METHODS We investigated MBC at our institution to evaluate outcomes and investigate the molecular profile of our cohort to determine the presence of mutations for which there are targeted therapies. RESULTS We found our cohort to consist mainly of the matrix-producing variant (72%) with 48% having the stereotypical estrogen receptor-negative/progesterone receptor-negative/human epidermal growth factor receptor-2-negative phenotype. While the overall survival of our cohort was an average of 1679 days (4.6 years), we had a surprising number of patients with second primaries (40%) and distant metastases (40%), yet few recurrences (12%). Molecular analysis of the tumors indicated that one gene mutation, CSFIR, was significantly associated with outcome (P = .021); however, the cohort was defined by frequent mutations in ERBB4 (36%), PIK3CA (48%), and FLT3 (60%), for which there are now targeted therapies. CONCLUSION While surgery is the appropriate first step in the management of this aggressive malignancy, the collection of data pertaining to the use of targeted agents, although anecdotal, may provide clues to better treatment for these patients.
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MESH Headings
- Biomarkers, Tumor/genetics
- Breast Neoplasms/classification
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/secondary
- Class I Phosphatidylinositol 3-Kinases/genetics
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Metaplasia/genetics
- Metaplasia/metabolism
- Metaplasia/pathology
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptor, ErbB-4/genetics
- Receptors, Colony-Stimulating Factor/genetics
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
- fms-Like Tyrosine Kinase 3/genetics
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16
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Tzanninis IG, Kotteas EA, Ntanasis-Stathopoulos I, Kontogianni P, Fotopoulos G. Management and Outcomes in Metaplastic Breast Cancer. Clin Breast Cancer 2016; 16:437-443. [PMID: 27431460 DOI: 10.1016/j.clbc.2016.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/21/2016] [Accepted: 06/05/2016] [Indexed: 02/07/2023]
Abstract
Metaplastic breast cancer (MBC) constitutes a rare clinical entity with special clinicopathologic, immunohistochemical, and molecular features. Resistance to systemic therapies, whether chemotherapy or hormonal therapy, is among its main characteristics, which in turn explains the poor prognosis and renders its management a challenge. Thus, the scope of the present review is to discuss the current therapeutic strategies for MBC in clinical practice and the corresponding outcomes and to suggest possible directions for future research. Potential novel targeted therapies could provide a hope for better outcomes but limited data are available owing to the rarity of MBC. As knowledge accumulates on the pathogenesis and genetic characteristics of MBC, emphasis should be given to the implementation of more targeted treatments, which will allow more efficient and individualized management of the disease.
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MESH Headings
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Clinical Trials as Topic
- Combined Modality Therapy/methods
- Disease-Free Survival
- Drug Resistance, Neoplasm
- Female
- Humans
- Immunohistochemistry
- Molecular Targeted Therapy/methods
- Precision Medicine/methods
- Prognosis
- Treatment Outcome
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Affiliation(s)
| | - Elias A Kotteas
- Athens Medical School, Athens, Greece; Oncology Unit, Third Department of Internal Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece
| | | | - Panagiota Kontogianni
- First Propaedeutic Surgical Department, Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - George Fotopoulos
- Athens Medical School, Athens, Greece; Oncology Unit, Third Department of Internal Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece.
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