Prognosis and effectiveness of chemotherapy for medullary breast carcinoma

Tomohiko Aihara; Hiraku Kumamaru; Makoto Ishitobi; Minoru Miyashita; Hiroaki Miyata; Kenji Tamura; Masayuki Yoshida; Etsuyo Ogo; Masayuki Nagahashi; Sota Asaga; Yasuyuki Kojima; Takayuki Kadoya; Kenjiro Aogi; Naoki Niikura; Kotaro Iijima; Naoki Hayashi; Makoto Kubo; Yutaka Yamamoto; Yoshinori Takeuchi; Shigeru Imoto; Hiromitsu Jinno

doi:10.1007/s10549-022-06749-3

Prognosis and effectiveness of chemotherapy for medullary breast carcinoma

Breast Cancer Res Treat. 2022 Dec;196(3):635-645. doi: 10.1007/s10549-022-06749-3. Epub 2022 Oct 23.

Authors

Tomohiko Aihara¹, Hiraku Kumamaru², Makoto Ishitobi³, Minoru Miyashita⁴, Hiroaki Miyata², Kenji Tamura⁵, Masayuki Yoshida⁶, Etsuyo Ogo⁷, Masayuki Nagahashi⁸, Sota Asaga⁹, Yasuyuki Kojima¹⁰, Takayuki Kadoya¹¹, Kenjiro Aogi¹², Naoki Niikura¹³, Kotaro Iijima¹⁴, Naoki Hayashi¹⁵, Makoto Kubo¹⁶, Yutaka Yamamoto¹⁷, Yoshinori Takeuchi¹⁸, Shigeru Imoto⁹, Hiromitsu Jinno¹⁹

Affiliations

¹ Breast Center, Aihara Hospital, 3-4-30, Makiochi, Minoh, Osaka, 562-0004, Japan. aiharat@aiharabreast.com.
² Department of Healthcare Quality Assessment, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
³ Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
⁴ Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
⁵ Department of Medical Oncology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
⁶ Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
⁷ Department of Radiology, Kurume University School of Medicine, 67 Asahisahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
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.
⁹ Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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.
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.
¹² Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Ko, Minamiumemoto-Machi, Matsuyama, Ehime, 791-0280, Japan.
¹³ Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
¹⁴ Department of Breast Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
¹⁵ Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
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.
¹⁷ Department of Breast and Endocrine Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto-Shi, Kumamoto, 860-8556, Japan.
¹⁸ Division of Medical Statistics, Department of Social Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-Ku, Tokyo, 143-8540, Japan.
¹⁹ Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.

PMID: 36273358
DOI: 10.1007/s10549-022-06749-3

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.

Keywords: Adjuvant chemotherapy; Medullary breast carcinoma; Prognosis.

MeSH terms

Breast Neoplasms* / pathology
Carcinoma, Ductal, Breast* / drug therapy
Carcinoma, Ductal, Breast* / pathology
Chemotherapy, Adjuvant
Female
Humans
Prognosis
Receptor, ErbB-2

Substances

Receptor, ErbB-2