Medullary breast carcinoma: Outcomes and prognosis with the utilization of chemotherapy

Abstract

671 Background: Medullary carcinoma of the breast is an uncommon histological type consisting of poorly differentiated cells surrounded by a prominent lymphoid stroma. It is also suggested that these lesions have good prognosis and therefore may not benefit from systemic therapy. We therefore report on our experience with this tumor type. Methods: 143 evaluable patients treated between 1980–2003 at UTMDACC were retrospectively reviewed on an IRB approved protocol. Pathology was reviewed. Outcomes were analyzed by administration of chemotherapy, use of hormonal therapy, pathologic size, and nodal status. Log-rank statistics were used for overall-, local-regional failure-free, and distant metastasis free- survival. Results: Mean age at diagnosis was 44 years (range 24–84)with a mean follow-up of 9 years (range 0.16- 23.3). 71% of patients recieved chemotherapy (n=102) with 88% having a doxorubicin-based regimen. 72% were ER-. 27 had positive nodes with only 6 patients having 4 or more nodes positive. 5 and 10 yr OS, LRFFS, and DMFS for all patients was 82%/75%, 86%/86%, and 84%/80% respectively. Improvement in 5 and 10 yr OS and DMFS was noted with chemotherapy (86%/79%) vs no chemoherapy (72%/66% P=.08) and ( 81%/81% vs 71%/71% P=.08). No improvement was noted with adjuvant hormonal therapy (n=21)(P=.5). 5 and 10 yr OS rates decreased with increasing tumor size with tumors 1 cm or less having 100%/100% vs tumors 1–3cm having 83%/83%, and tumors 3 cm or larger having 74%/69% values (p=.13). LN- patients likewise had improved 5 and 10 yr OS rates (87%/80% vs 75%/61%)(P=.07). No significant difference in OS, LRFFS, or DMFS was noted after stratification of lymph nodes (1–3 vs 4+). Conclusions: Patients with medullary breast cancer benefited from the use of adjuvant chemotherapy. Limited patient numbers preclude comment on adjuvant hormones. Tumors less than 1 cm were most favorable as were those without nodal metastasis. In our series, patients with + nodes and tumor size greater than 1 cm had prognosis similar to that ascribed to invasive ductal carcinoma NOS and may benefit from systemic regimens. Larger datasets should be examined to further clarify therapy recommendations. No significant financial relationships to disclose.