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The Metaplastic Conundrum: A National Cancer Database Analysis of Metaplastic versus Triple-Negative Ductal Breast
Catherine G Pratt1, Paul H McClelland2, Szu-Aun Long2
1Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. prattcg@ucmail.uc.edu.
Metaplastic breast cancer (MpBC) patients have worse survival than triple-negative ductal breast cancer (TN-IDC). Neoadjuvant chemotherapy (NAC) for MpBC shows worse survival unless a complete response is achieved, highlighting the need for optimized treatment sequences.
Area of Science:
- Oncology
- Breast Cancer Research
- Clinical Therapeutics
Background:
- Metaplastic breast cancer (MpBC) historically shares treatment strategies with triple-negative ductal breast cancer (TN-IDC).
- MpBC exhibits a poorer survival rate compared to TN-IDC despite similar treatment approaches.
- This study investigates treatment patterns and outcomes for MpBC versus TN-IDC.
Purpose of the Study:
- To describe neoadjuvant systemic therapy (NAC) rates and response in MpBC.
- To compare survival outcomes between triple-negative MpBC (TN-MpBC), biomarker-positive MpBC (nTN-MpBC), and TN-IDC.
- To evaluate the impact of different treatment sequences on MpBC survival.
Main Methods:
- Utilized the National Cancer Database (2011-2021) for patients with non-metastatic MpBC or TN-IDC.
- Employed one-to-one propensity score matching to compare TN-MpBC and TN-IDC cohorts.
- Analyzed survival data based on treatment modalities and pathologic response to NAC.
Main Results:
- Neoadjuvant chemotherapy (NAC) for TN-MpBC increased from 18.3% to 31.5% by 2021.
- MpBC cohorts demonstrated higher NAC non-response rates and lower overall survival compared to TN-IDC.
- Adjuvant therapy showed significantly better survival for MpBC than other systemic therapy sequences; NAC was associated with worse survival unless a complete pathologic response was achieved.
Conclusions:
- MpBC treatment involves surgery and systemic therapy, with rising NAC use in TN-MpBC.
- MpBC patients experience inferior survival compared to TN-IDC.
- Optimizing systemic treatment sequences is crucial for improving MpBC outcomes, particularly when complete pathologic response to NAC is not achieved.
