Metaplastic Breast Cancer: Epidemiology,

Prognosis, and Response to Neoadjuvant

Therapy.

Dr. sherif Refaat , MSc, MD

Lecturer of medical Oncology, OCMU
Faculty of Medicine
Mansoura University
 Journal of Surgical Chronicles
Accepted : 26/6/2022

Background
• Metaplastic breast cancer (MPBC) contains one or more cell lines that have undergone metaplastic differentiation,
converting from glandular to non-glandular morphology. Metaplastic cancer commonly harbors a triple-negative
breast cancer (TNBC) phenotype, yet has a worse prognosis and decreased survival compared to the non-
metaplastic TNBC. (Reddy TP et al.,2020).

Aim of the study

• In our study, we illustrated the epidemiological, clinical, and oncological outcomes of a twelve-year experience
with metaplastic breast carcinoma. In addition, we analyzed our outcomes in comparison with those in the
published literature.
Patients and Methods:
• All procedures are conducted in accordance with the guidelines of our ethics committee (International Review
Board of Mansoura University, code Number R/22.09.1812)

• This is a retrospective study, where the institutional registry at the Oncology Center, Mansoura University (OCMU)
was revised for patients diagnosed with metaplastic breast cancer from January 2009 to September 2021.
60 patients were included in the study .

• The primary endpoint was disease-free survival.

• The secondary endpoints were recurrence and distant metastasis.

Results:

Table 1: Basic epidemiologic criteria

Results:
 Results:

• The 5-year DFS was 32%. The DFS was

significantly related to the type of
axillary surgery where those who did
not do axillary staging had the worst
prognosis, T stage, pathologic node
positive and progression on
neoadjuvant therapy.

Table 2: Factors predicting disease-free survival

Discussion:
• Metaplastic breast cancer (MPBC) is a rare variant that is characterized by the presence of at least two histological
types (usually epithelial and mesenchymal). It is typically negative for hormonal & human epidermal growth factor-
2 receptors. Yet, it is considered more aggressive than the triple-negative phenotype with a higher tendency for
hematogenous spread carrying a worse prognosis and survival .The five-year disease-free survival in our study
cohort was 32% which is coping with the known aggressive behavior of such tumor. (He X et al .,2019).
• IHC : +ve CK 5/6 , +ve P53 “sensitive and specific marker”.

• Variants of MPBC have been recognized according to the WHO classifications. They include spindle cell carcinoma,
carcinoma with mesenchymal differentiation, squamous cell carcinoma, fibromatosis-like metaplastic carcinoma,
and low-grade adeno-squamous carcinoma. The last two categories are considered the least aggressive subtypes
while the spindle cell type is considered the most aggressive one.
Discussion:
• The characteristics which can be used as predictors of bad prognosis include the large tumor size, positive lymph
node status, high ki67, loss of cytokeratin expression, and EGFR overexpression. (Han M et al.,2019).
• MPBC is difficult to be diagnosed preoperatively with CNB , and can’t be picked up radiologically.
• In our study. The most important significant prognostic factors were the tumor size, lymph node status & progression
on neoadjuvant therapy.
• 23% received NACT “75% showed regression but no one showed pCR”
• In our study , lung was the most common site of metastasis,, but less likely to have LN infilteration.
• Because of the rarity of the disease, there are no available standard guidelines for management. So it is treated like
infiltrating duct carcinoma with surgery and radiotherapy being the standard of care for localized disease. Despite
being relatively chemoresistant. Systemic chemotherapy shows improved survival in such patients.
• Metastatic MPBC : showed better response with sarcoma like regimens “ targeted and immunotherapy are being
evaluated”

• The limitations of the study are its retrospective nature, the heterogeneity in treatment protocols, missed data
about some patients' overall survival as well as the defects in different receptor subtyping.
Conclusion:

• Metaplastic breast cancer is a quite uncommon breast cancer that is difficult to pick up in

imaging and even in the core needle biopsy. It tends to metastasize early and more frequently

to the lungs.

• The majority are triple-negative. Complete pathologic response is not anticipated in these

patients with neoadjuvant chemotherapy and only one-third of the patients will be disease-

free for 5 years.

Thank
you