Multi-center Investigation of the Clinical and Pathological Characteristics of Inflammatory Breast Cancer Based on Chinese Society of Breast Surgery (CSBrs-007)
Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer, accounting for only 2% of all breast cancer cases, according to data from the Surveillance, Epidemiology, and End Results (SEER) registry. Despite its rarity, IBC is associated with a poor prognosis and high mortality rates due to its rapid progression and tendency for early metastasis. The diagnosis of IBC is primarily clinical, characterized by diffuse erythema, edema (peau d’orange), and the absence of a distinct breast mass. These symptoms result from tumor emboli invading the dermal lymphatic vessels, which may or may not be visible on skin biopsy. Given the aggressive nature of IBC, understanding its clinicopathological features, molecular characteristics, and treatment outcomes is crucial for improving patient care.
This multi-center study, conducted under the auspices of the Chinese Society of Breast Surgery (CSBrs-007), aimed to provide a comprehensive analysis of the clinical and pathological characteristics of IBC among Chinese patients. The study included 95 patients diagnosed with IBC between January 2017 and December 2018, treated across 30 centers in China. Data were collected retrospectively using a standardized electronic questionnaire, capturing demographic information, pathological findings, treatment modalities, and follow-up outcomes. The study sought to fill the gap in the literature regarding IBC in the Chinese population, as most previous research has relied on data from Western countries or single-center studies.
The demographic and clinical characteristics of the study participants revealed several key findings. The mean age of the patients at diagnosis was 50.55 years, with a mean body mass index (BMI) of 25.4 kg/m². Premenopausal status was noted in 54.4% of the patients, and 8.5% had a family history of malignant tumors. The majority of patients presented with stage III (80%) or stage IV (20%) disease, with bone being the most common site of distant metastasis. Pathological analysis indicated that invasive ductal carcinoma (IDC) was the most common histological type, accounting for 86.8% of cases, followed by invasive lobular carcinoma (ILC) at 5.3%. In terms of molecular subtypes, hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) was the most prevalent (41.5%), followed by HR-/HER2+ (20.1%), HR+/HER2+ (19.1%), and HR-/HER2- (19.1%).
The study also examined the treatment patterns and outcomes among the patients. Neoadjuvant chemotherapy was administered to 87.7% of patients with stage III IBC, predominantly using anthracycline and taxane-based regimens. Surgical treatment was performed in 91.9% of patients, with modified radical mastectomy being the most common procedure (77.0%). Immediate breast reconstruction was performed in 8.1% of cases. Among patients without distant metastases, the Miller-Payne grading system was used to evaluate the efficacy of neoadjuvant chemotherapy, with 14% of patients achieving a grade 5 response, indicating a complete pathological response (pCR). The Kruskal-Wallis test revealed significant differences in Ki-67 expression and chemotherapy efficacy among different molecular subtypes, with HR+/HER2- and HR-/HER2- tumors showing the most pronounced differences.
The findings of this study underscore the aggressive nature of IBC and the importance of tailored treatment strategies. The high prevalence of lymph node metastasis (75.8%) and distant metastasis (21.4%) at diagnosis highlights the need for early detection and aggressive systemic therapy. The predominance of IDC and the distribution of molecular subtypes align with previous studies, reinforcing the heterogeneity of IBC and the need for subtype-specific treatment approaches. The use of neoadjuvant chemotherapy, particularly anthracycline and taxane-based regimens, reflects current guidelines and underscores its role in downstaging tumors and improving surgical outcomes.
The study also provides valuable insights into the role of breast reconstruction in IBC. Traditionally, breast reconstruction has been contraindicated in IBC due to concerns about recurrence and delayed adjuvant therapy. However, recent advances in multimodal therapy have improved survival outcomes, making immediate breast reconstruction a viable option for select patients. In this study, 8.1% of patients underwent immediate breast reconstruction, a higher rate than reported in previous studies, suggesting a shift in clinical practice.
Despite its contributions, the study has several limitations. The retrospective design introduces potential biases, and the small sample size may limit the generalizability of the findings. Additionally, missing data for some variables could have affected the statistical power of the analysis. Nonetheless, the study provides a valuable foundation for future research on IBC in the Chinese population.
In conclusion, this multi-center study offers novel insights into the clinicopathological characteristics and treatment status of IBC in China. The findings highlight the aggressive nature of the disease, the importance of subtype-specific treatment approaches, and the evolving role of breast reconstruction in IBC management. By shedding light on the unique features of IBC in the Chinese population, this study paves the way for further research and the development of targeted therapies to improve patient outcomes.
doi.org/10.1097/CM9.0000000000001104
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