Clinical outcomes and patterns of care in the treatment of carcinosarcoma of the breast

Abstract

Purpose Carcinosarcoma of the breast is a rare yet highly aggressive tumor accounting for <1% of all breast cancers, for which guidance on optimal management and prognosis are sparse. The purpose of this study was to investigate population‐based treatment patterns and overall survival (OS) outcomes in patients with this diagnosis. Materials and Methods We queried the National Cancer Database for patients diagnosed with carcinosarcoma of the breast. All patients included were treated with surgery in the form of mastectomy or lumpectomy, with or without chemotherapy and/or radiation therapy. Patients with metastatic disease were excluded. Kaplan‐Meier analysis was used to estimate OS. Univariate and multivariable Cox analyses were used to determine predictive factors of OS. Results A total of 329 patients from 2004 to 2012 were identified. Median age at diagnosis was 58 years (range, 24‐90). Patients had T1 (21%), T2 (44%), T3 (25%), or T4 disease (10%). Most patients were node‐negative at diagnosis (77%). Breast conservation surgery was utilized in 33% of patients. Chemotherapy was used in 66% of patients. Less than half (44%) of patients received radiation therapy to a median dose of 50.4 Gy (range 35‐56 Gy), with a median 10 Gy boost used in 76%. With a median follow‐up of 40.0 months, 3‐ and 5‐year OS for all patients was 74% and 60%, respectively. Kaplan‐Meier estimates revealed the 3‐yr OS was 80% in patients receiving chemotherapy vs 59% without chemotherapy (P < 0.001). The 3‐yr OS was 82% in patients receiving RT vs 66% without RT (P = 0.001). On multivariable analysis, OS was significantly influenced by Charlson‐Deyo comorbidity index, insurance status, clinical T stage, surgical margin status, and treatment group, with trimodality therapy (HR: 0.45, 95% CI: 0.27‐0.78; P = 0.004) and surgery plus CT (HR: 0.54, 95% CI: 0.33‐0.90; P = 0.02) being associated with the greatest OS. Logistic regression revealed only younger patients were more likely to receive trimodality therapy. Conclusions Carcinosarcoma of the breast is associated with relatively poor rates of OS. The addition of CT and RT to surgery improves OS. Trimodality therapy and surgery plus CT were associated with the greatest OS compared to surgery alone.

Metaplastic Breast Carcinoma in a 37-Year-Old Female: A Case Report

“…The most recent international guidelines do not differentiate the treatment of patients with MBC from other breast-invasive tumors [ 8 , 9 ]. However, due to evidence of chemoresistance, the role of multimodal therapy remains an area of active investigation with growing evidence [ 3 ].…”

“…Because of its rarity and heterogeneity, the management of these patients is challenging. Recent data suggest that trimodal therapy consisting of surgery, chemotherapy, and radiotherapy improves overall survival, although details regarding specific chemotherapeutic agents are lacking [ 3 ]. In the absence of randomized clinical trials, there is an urgent need for clinicians to share their experiences.…”

Clinicopathological characteristics and survival outcomes in breast carcinosarcoma: A SEER population-based study

“…Recently, Kennedy et al. [ 14 ] analyzed 329 early/or locally advanced breast carcinosarcoma patients from 2004 to 2012 through the National Cancer Database. In that study, comorbidity index, insurance status, clinical T stage, surgical margin status, and treatment modality were associated with the greatest OS.…”

“…Due to the specific histologic feature, breast carcinosarcoma may have different biological characteristics when compared with IDC. Because of the rarity of breast carcinosarcoma, previous publications about this disease were a few small sample size retrospective analyses [ [8] , [9] , [10] , [11] , [12] , [13] , [14] ] and a few case reports [ [15] , [16] , [17] , [18] , [19] , [20] ]. From these limited studies, it appears that breast carcinosarcoma is always aggressive, poorly differentiated, and hormone receptor-negative [ 8 , 10 ].…”

Recurrent Carcinosarcoma of the Breast: A Case-Report

“…Mean age of diagnosis is fifth to sixth decade of life. Histopathologically, carcinosarcoma is a poorly differentiated cancer that is composed of a mixture of carcinoma cells and nonepithelial mesenchymal components that included elements of chondroid, osteoid, rhabdomyoid and neuroglial differentiation [2]. According to W.H.O.…”