Triple‐Negative Subtype Predicts Poor Overall Survival and High Locoregional Relapse in Inflammatory Breast Cancer

Background. Numerous studies have demonstrated that expression of estrogen/progesterone receptor (ER/PR) and human epidermal growth factor receptor (HER)‐2 is important for predicting overall survival (OS), distant relapse (DR), and locoregional relapse (LRR) in early and advanced breast cancer patients. However, these findings have not been confirmed for inflammatory breast cancer (IBC), which has different biological features than non‐IBC. Methods. We retrospectively analyzed the records of 316 women who presented to MD Anderson Cancer Center in 1989–2008 with newly diagnosed IBC without distant metastases. Most patients received neoadjuvant chemotherapy, mastectomy, and postmastectomy radiation. Patients were grouped according to receptor status: ER+ (ER+/PR+ and HER‐2−; n = 105), ER+HER‐2+ (ER+/PR+ and HER‐2+; n = 37), HER‐2+ (ER−/PR− and HER‐2+; n = 83), or triple‐negative (TN) (ER−PR−HER‐2−; n = 91). Kaplan–Meier and Cox proportional hazards methods were used to assess LRR, DR, and OS rates and their associations with prognostic factors. Results. The median age was 50 years (range, 24–83 years). The median follow‐up time and median OS time for all patients were both 33 months. The 5‐year actuarial OS rates were 58.7% for the entire cohort, 69.7% for ER+ patients, 73.5% for ER+HER‐2+ patients, 54.0% for HER=2+ patients, and 42.7% for TN patients (p < .0001); 5‐year LRR rates were 20.3%, 8.0%, 12.6%, 22.6%, and 38.6%, respectively, for the four subgroups (p < .0001); and 5‐year DR rates were 45.5%, 28.8%, 50.1%, 52.1%, and 56.7%, respectively (p < .001). OS and LRR rates were worse for TN patients than for any other subgroup (p < .0001–.03). Conclusions. TN disease is associated with worse OS, DR, and LRR outcomes in IBC patients, indicating the need for developing new locoregional and systemic treatment strategies for patients with this aggressive subtype. 摘要 背景 大量研究显示, 雌激素/孕激素受体 (ER/PR) 和人类表皮生长因子受体 (HER) ‐2表达对早期和晚期乳腺癌患者总生存 (OS) , 远处复发 (DR) 和局部区域复发 (LRR) 的预测非常重要. 但这些发现尚未在炎性乳腺癌 (IBC) 中证实, IBC的生物学特征不同于非IBC. 方法 回顾性分析1989∼2008年间MD Anderson癌症中心就诊的316例无远处转移的新确诊IBC患者的医学记录. 多数患者接受新辅助化疗, 乳房切除术和术后放疗. 患者按照激素受体状态分四组: ER+ (ER+/PR+和HER‐2‐; n=105) , ER+HER‐2+ (ER+/PR+和HER‐2+; n=37) , HER‐2+ (ER‐/PR‐和HER‐2+; n=83) 或三阴性 (TN) (ER‐/PR‐HER‐2‐; n=91) . 采用Kaplan–Meier法和Cox比例风险模型评估LRR, DR和OS率及其与预后因素的关联. 结果 中位年龄为50岁 (范围24∼83岁) . 所有患者中位随访期和中位OS期均为33个月. 整个队列, ER+, ER+HER‐2+, HER‐2+和TN患者的5年精算OS率分别为58.7%, 69.7%, 73.5%, 54.0%和42.7% (P