Prognostic Factors and Long-Term Survivors in Inflammatory Breast Cancer.

Abstract

Abstract Background: Inflammatory Breast Cancer (IBC) carries a worse overall survival and demonstrates distinct clinicopathologic qualities which require refinement of prognostic indicators specific to IBC. We hypothesized that given IBC's typically rapid course, nodal status would not be a significant prognostic factor. We also investigated the impact of treatment with radiation and surgery on IBC survival.Material and Methods: Retrospective data from the Surveillance, Epidemiology, and End Results of the National Cancer Institute (SEER 13 and 17 registries) were used to evaluate the prognostic effects of nodal status, surgical resection, and radiation on mortality of patients with IBC. We compared survival between patients with or without positive lymph node status and treatment with radiation, surgery, and those patients treated with both. Data were subjected to multivariate statistical analysis.Results: A total of 3755 IBC patients were diagnosed and reported to SEER between 1995 and 2005. IBC survival appears independent of lymph node status with mean survival times of 34 months for node negative patients and 32 months for node positive patients (figure 1, p= 0.11). We identified 735 cases with adequate local treatment records and follow-up information. In this subset we compared survival between groups that received both surgery and radiation (SR), groups that received one of these therapies independently (S or R respectively), to those without either therapy (NT, no therapy) given positive lymph node status at diagnosis (fig. 2, p<0.001).Discussion: Our data suggests that the prognosis of IBC is not related to lymph node status at the time of diagnosis. Because patients with IBC amenable to surgical intervention or radiation are likely to have more favorable biology then those who progress on chemotherapy, it remains difficult to quantify the impact of local therapies. NCCN guidelines currently recommend first-line chemotherapy before moving to local treatments; therefore one limitation of our study is the assumption that centers reporting data to SEER follow NCCN guidelines. Of special interest is the substantial number of patients that show prolonged survival with local therapies. This supports previous reports that about 30% of patients who complete chemotherapy, surgery and radiation therapy may survive five years or more after IBC diagnosis. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4039.