Medullary Breast Carcinoma: Prognostic Implications of P53 Expression

Abstract

Medullary breast carcinoma (MBC) is a rare pathological type of breast cancer. The rate of p53 protein accumulation is higher in MBC than in common invasive ductal carcinoma. Whether this particular feature of MBC influences the outcome after treatment is unknown. We retrospectively analyzed the characteristics, treatment and outcome of 71 patients with MBC treated between 1981 and 1996. The median age was 51 years (range 27-81) and the median clinical tumor size was 25 mm (range 0-70 mm). Breast-conserving treatment was offered when possible: 55 patients had undergone a tumorectomy and radiotherapy while 16 patients had undergone a mastectomy. p53 protein accumulation was determined by immunohistochemistry on paraffin-embedded tumor specimens from 58/71 samples available for this study. The median follow-up for the 56 survivors was 113 months (range 30-241). The 10-year survival and metastasis-free survival rates were 81% and 81.4%, respectively. The local recurrence rate was 16.4%. The two factors predicting outcome were pathological axillary node involvement in the 60 patients who underwent axillary dissection and adjuvant chemotherapy. p53 accumulation was found in 33/58 patients (57%). p53 status was not predictive of survival nor of distant or local recurrences. We confirm that medullary breast carcinoma has a favorable prognosis despite its aggressive pathological features. p53 protein accumulation, found in the majority of MBCs, was not related to outcome.

Identification of typical medullary breast carcinoma as a genomic sub-group of basal-like carcinomas, a heterogeneous new molecular entity

“…Our study demonstrates that MBCs effectively presented a high number of gains and losses, suggesting a putative alteration within a DNA damage repair process. If confirmed, this hypothesis could lead to an explanation of their higher sensitivity to radiation therapy and their favorable local and regional outcome [11,12]. These features have already been reported for BRCA1/2 -related tumors [37,38].…”

“…MBCs have recently been shown to share the basal-like immunophenotype [9], and some morphological traits that have been reported to be specific for BLC with poor prognosis, such as tumor necrosis, a pushing border of invasion, and a stromal lymphocytic infiltrate [22,25], are also observed in MBCs. These phenotypic and immunophenotypic similarities suggest that these two entities have a common biology despite the fact that MBC presents a more favorable outcome [11,12]. In the present study we wished to define the possible phenotypic and genetic differences between MBCs and BLCs with a view to understanding the major differences in clinical outcome between these tumors.…”

High expression of indoleamine 2,3‐dioxygenase in the tumour is associated with medullary features and favourable outcome in basal‐like breast carcinoma

“…It was also suggested that lymphoid infiltration is of poor prognosis in Grade‐3 BC patients younger than 35,10 and in invasive micropapillary carcinomas 11. In contrast, MBC is characterised by both improved clinical outcome and prominent lymphocyte infiltrate 12, 13. In a recent study of a large BC series, prominent inflammation was associated with better prognosis 14.…”

Update on triple-negative breast cancer: prognosis and management strategies

“…In a series of medullary carcinomas (n = 41), high radiosensitivy was suggested (7% of the patients had a complete response after a dose of 55–60 Gy) and chemotherapy had no effect on the rate of recurrence or survival (6-year local recurrence-free survival, metastasis-free survival, and survival rates were 86%, 83%, and 83%, respectively) 65. Another series of medullary carcinomas (n = 71), also presented with good outcomes (10-year distant metastasis-free survival of 81.4%) with chemotherapy only given to a minority (n = 11) 66. Good outcomes (14-year distant recurrence-free interval of 89% for ER-negative medullary breast cancer) were also noticed in the International Breast Cancer Study Group (IBCSG) (n = 127), but almost 70% received adjuvant chemotherapy 67.…”