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Prognoses of T4 Breast Cancer Subsets

From the Department of Surgery (ME-T), Columbia Presbyterian Medical Center, New York, New York; Dr. Everett Chalmers Regional Hospital (SH), Oncology Department, Fredericton, New Brunswick, Canada; Department of Scientific Computing (JW), Division of Hematology, Department of Medicine (AC, ASB), and Department of Radiation Oncology (CS), Health Sciences Center at Brooklyn, State University of New York, New York; and Allan Blair Cancer Center (HC), Department of Medical Oncology, Regina, Saskatchewan, Canada.

Correspondence: Address correspondence and reprint requests to: Albert S. Braverman, MD, Box 55, Heath Sciences Center at Brooklyn, State University of New York, 450 Clarkson Ave., Brooklyn, NY 11203-2098; Fax: 718-270-1544; E-mail: abraverman{at}netmail.hscbklyn.edu

Background: The relative prognoses of subsets of patients with T4 breast tumors, since the advent of neoadjuvant therapy, are unknown, although inflammatory carcinoma (T4d) is considered to have the worst prognosis.

Methods: Subsets of T4 patients were analyzed for the incidence of distant metastases at presentation (M1; n = 263). T4M0 patients treated with neoadjuvant therapy (n = 126) were analyzed for relapse-free survival (RFS). T4d tumors with (Cut/CW+) and without (Cut/CW-) skin nodules, posterior fixation, or both were analyzed separately.

Results: Fewer patients with T4d (Cut/CW-) tumors had distant metastases at presentation than T4d (Cut/CW+) patients or T4b and T4c patients (P = .001, .001, and .009, respectively). RFS was longer for T4b patients than for T4c patients (P = .018) or T4d (Cut/CW+) patients (P = .003). RFS of the T4d (Cut/CW+) patients was shorter than for T4d (Cut/CW-) patients (P = .050).

Conclusions: The incidence of distant metastases at presentation was lowest, and RFS was longest, for patients with T4d tumors not grossly involving the skin or posterior structures. Patients whose tumors grossly invaded both skin and posterior structures (T4c) or those with T4d tumors grossly invading either most frequently presented with distant metastases and had the shortest RFS.

Key Words: Breast cancer • Inflammatory carcinoma • T4 breast tumor • Prognosis

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