Abstract
BackgroundDistant metastatic disease is frequently observed in inflammatory breast cancer (IBC), with a poor prognosis as a consequence. The aim of this study was to analyze the association of hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) based breast cancer subtypes in stage IV inflammatory breast cancer (IBC) with preferential site of distant metastases and overall survival (OS).MethodsFor patients with stage IV IBC, diagnosed in the Netherlands between 2005 and 2016, tumors were classified into four breast cancer subtypes: HR+/HER2−, HR+/HER2+, HR−/HER2+, and HR−/HER2−. Patient, tumor, and treatment characteristics and sites of metastases were compared. OS of the subtypes was compared using Kaplan-Meier curves and the log-rank test. Association between subtype and OS was assessed in multivariable models using logistic regression.ResultsIn total, 744 eligible patients were included: 340 (45.7%) tumors were HR+/HER2−, 148 (19.9%) HR−/HER2+, 131 (17.6%) HR+/HER2+, and 125 (16.8%) HR−/HER2−. Bone was the most common metastatic site in all subtypes. A significant predominance of bone metastases was found in HR+/HER2− IBC (71.5%), and liver and lung metastases in the HR−/HER2+ (41.2%) and HR−/HER2− (40.8%) subtypes, respectively. In multivariable analysis, the HR−/HER2− subtype was associated with significantly worse OS as compared to the other subtypes.ConclusionBreast cancer subtypes in stage IV IBC are associated with distinct patterns of metastatic spread and display notable differences in OS. The use of breast cancer subtypes can guide a more patient-tailored staging directed to metastatic site and extend of disease.
Highlights
Inflammatory breast cancer (IBC) has the clinical appearance of inflammation of the breast with pathological evidence of malignancy
We recently demonstrated that hormone receptor (HR)/human epidermal growth factor receptor-2 (HER2)-based breast cancer subtypes influence prognosis and treatment response in patients with inflammatory breast cancer (IBC) without distant metastases [5]
Nearly 40% of patients with IBC are diagnosed with synchronous distant metastases, and it is unknown what role the HR/HER2-based subtypes play in this stage [6]
Summary
Inflammatory breast cancer (IBC) has the clinical appearance of inflammation of the breast with pathological evidence of malignancy. It comprises 1% of all breast cancers and is the most aggressive form of breast cancer [1]. We recently demonstrated that HR/HER2-based breast cancer subtypes influence prognosis and treatment response in patients with IBC without distant metastases [5]. The aim of this study was to analyze the association of hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) based breast cancer subtypes in stage IV inflammatory breast cancer (IBC) with preferential site of distant metastases and overall survival (OS)
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