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Mastoraki A, Tsamopoulou M, Stamatis FK, Strimpakos A, Mouchtouri E, Panagi C, Mela E, Mastoraki S, Kechagias A, Schizas D. Carcinosarcoma of the breast: Facing the challenge of a rare nosologic entity. World J Clin Cases 2025; 13:99619. [PMID: 39823109 PMCID: PMC11577508 DOI: 10.12998/wjcc.v13.i2.99619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 10/02/2024] [Accepted: 10/20/2024] [Indexed: 11/08/2024] Open
Abstract
Carcinosarcoma (CS), also known as metaplastic breast carcinoma with mesenchymal differentiation, is one of the five distinct subtypes of metaplastic breast cancer. It is considered as a mixed, biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone. Although cellular origin of this neoplasm remains controversial, most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation. Despite recent research on the therapeutic strategies against CS neoplastic disorders, surgical resection appears the only potentially curative approach. Since CS metastasize by the lymphatic route, axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented. Nevertheless, the tumor also presents a hematogenous metastatic pattern including pleural, pulmonary, liver, brain and less commonly bone metastases. Thus, surgical removal of breast CS does not necessarily ensure patient's long-term recovery. Moreover, alternative therapies, such as radio- and chemotherapy proved insufficient and 5-year survival rate is limited. Nevertheless, there is evidence that following surgery, the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone. The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread. Clinical features, histogenesis, morphological and immunochemical findings are discussed, while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.
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Affiliation(s)
- Aikaterini Mastoraki
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Maria Tsamopoulou
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | | | - Ero Mouchtouri
- Department of Radiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Christiana Panagi
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Evgenia Mela
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Sotiria Mastoraki
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | - Dimitrios Schizas
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
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2
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Tang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, Qiu M. Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open 2023; 13:e077974. [PMID: 38101828 PMCID: PMC10729011 DOI: 10.1136/bmjopen-2023-077974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Carcinosarcoma (CS) is a rare and biphasic malignancy characterised by a highly invasive biological nature and poor prognosis. This study explored the epidemiology, site-specific characteristics and survival outcome of CS. DESIGN We conducted a retrospective study in the Surveillance, Epidemiology and End Results (SEER) database (1975-2018) for primary CS. SETTING AND PARTICIPANTS SEER database includes publicly available information from regional and state cancer registries in the US centres. A total of 5042 CS patients were identified. We selected the top five anatomic CS (uterus, double adnexa, lung, bladder and breast) patients for further analysis. PRIMARY OUTCOME MEASURES Incidence was estimated by geographical region, age, sex, race, stage and primary site. Trends were calculated using joinpoint regression. The cancer-specific survival (CSS) rate and initial treatment were summarised. RESULTS Nearly 80% of CS occurred in the uterus and double adnexa, followed by lung, bladder and breast. The elderly and black population presented the highest age-adjusted rate of CS. The rates of distant metastasis in CS progressively increased from 1989 to 2018. Atlanta was the area with the highest incidence at 0.7 per 100 000. Pulmonary and bladder CS more frequently occurred in men and were diagnosed with regional stage. Distant metastasis was mostly found in ovary/fallopian tube CS. Radiotherapy was more commonly applied in uterine CS, while adnexa CS cases were more likely to receive chemotherapy. Multiple treatments were more used in breast CS. Pulmonary CS seemed to suffer worse CSS (median: 9.92 months), for which radiotherapy might not provide survival benefits (HR 0.60, 95% CI 0.42 to 0.86). Compared with the common histological types in each site, CS had the shortest survival. CONCLUSIONS CS has unique clinical features in each primary site. Substantial prognosis variances exist based on tumour locations. The aggressive course is the common feature in CS at all sites.
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Affiliation(s)
- Lian-Sha Tang
- West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Wen Zhou
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Ling Wang
- West China Hospital of Sichuan University, Chengdu, China
| | - Guo-Xu Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | - Chen-Hao Xu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Abdominal Oncology, West China Hospital of Sichuan University, Chengdu, China
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3
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Chen L, Meng Z, Zhou Z, Li X, Zhao L, Jia Z, Chen J, Tian Y, Meng Q, Liu Y. Immunotherapy Combined with Chemotherapy in Relapse Metaplastic Breast Cancer. Onco Targets Ther 2023; 16:885-890. [PMID: 37927329 PMCID: PMC10624194 DOI: 10.2147/ott.s435958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Metaplastic breast cancer (MBC) is a rare disease, and there was rarely reported the treatment after recurrence and metastasis. Here, we report the treatment of an adult patient who suffered from MBC with lung, lymph nodes and left pleura metastasis after radical surgery. The next-generation sequencing result demonstrated that it had tumor mutational burden (TMB) of 12.0 Muts/Mb and microsatellite stability. The patient received sintilimab, an immune checkpoint inhibitor, plus chemotherapy and achieved partial response (PR). This is a report of a good outcome of metastatic MBC achieving 24 months of progression-free survival (PFS) and 39 months of overall survival (OS) with a combination therapy of immune checkpoint inhibitor and chemotherapy. Immuno-chemotherapy may have antitumor activity for relapse MBC. TMB may serve as a potential predictor associated with PD-1 inhibitors in MBC and help clinicians make an optimum treatment strategy.
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Affiliation(s)
- Ling Chen
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050011, People’s Republic of China
| | - Zhe Meng
- The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei Province, 054000, People’s Republic of China
| | - Zhiguo Zhou
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050011, People’s Republic of China
| | - Xiaomin Li
- The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei Province, 054000, People’s Republic of China
| | - Liyan Zhao
- The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei Province, 054000, People’s Republic of China
| | - Zhaohui Jia
- The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei Province, 054000, People’s Republic of China
| | - Jingli Chen
- Hebei Medical University, Shijiangzhuang, Hebei Province, 050011, People’s Republic of China
| | - Ye Tian
- Hebei Medical University, Shijiangzhuang, Hebei Province, 050011, People’s Republic of China
| | - Qingju Meng
- The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei Province, 054000, People’s Republic of China
| | - Yibing Liu
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050011, People’s Republic of China
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4
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Corso G, Criscitiello C, Nicosia L, Pesapane F, Vicini E, Magnoni F, Sibilio A, Zanzottera C, De Scalzi AM, Mannucci S, Marabelli M, Calvello M, Feroce I, Zagami P, Porta FM, Toesca A, Tarantino P, Nicolò E, Mazzarol G, La Vecchia C, Bonanni B, Leonardi MC, Veronesi P, Fusco N. Metaplastic breast cancer: an all-round multidisciplinary consensus. Eur J Cancer Prev 2023; 32:348-363. [PMID: 37021548 DOI: 10.1097/cej.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Metaplastic breast cancer (MpBC) is a rare and aggressive histologic subtype of breast cancer (BC) characterized by the presence of at least two cellular types, commonly epithelial and mesenchymal components. Despite growing evidence that MpBC is a unique entity, it has long been treated as a variant of nonspecial type (NST) BC. MpBC typically shows the phenotype of triple-negative breast cancer (TNBC), but compared to NST-TNBC, it is a relatively chemorefractory tumor associated with worse outcomes. Therefore, there is an urgent need to develop management guidelines specifically for MpBC to improve the prognosis of patients with early MpBC. This expert consensus aims to guide diagnosis and standardize clinical management of early MpBC among treating physicians. We provide guidance on the challenging radiological and pathological diagnosis of MpBC. Evidence on the involvement of genetic predisposition in the development of MpBC is also explored. We emphasize the importance of a multidisciplinary approach for the treatment of patients with early MpBC. The optimal surgery and radiotherapy approach is presented, as well as the opportunity offered by novel therapeutic approaches to increase treatment response in this chemoresistant subtype. Appropriate management of patients with MpBC is critical to reduce the high risk of local and distant recurrence that characterizes this disease.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
- European Cancer Prevention Organization (ECP)
| | - Carmen Criscitiello
- Department of Oncology and Hemato-Oncology, University of Milan
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Luca Nicosia
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Elisa Vicini
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Andrea Sibilio
- Division of Breast Surgery Forlì (Ravenna), AUSL Romagna, Ravenna
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Sara Mannucci
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Monica Marabelli
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
- Division of Hematology, Clinica Moncucco, Lugano, Switzerland
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Paola Zagami
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Department of Biomedical, Surgical and Dental Sciences
| | | | - Antonio Toesca
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Paolo Tarantino
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Division of Breast Oncology, Dana-Farber Cancer Institute, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eleonora Nicolò
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Giovanni Mazzarol
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, and
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan
- Harvard Medical School, Boston, MA, USA
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5
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Leng PN, Wan Zain WZ, Mohammad Azmi MAF, Yahya MM, Azis KA, Mat Johar SFN, Wan Sulaiman WA, Balingi D, Tuan Sharif SE, Wan Abdul Rahman WF, Chiew Chea L, Haron J. Carcinosarcoma: A Rare and Aggressive Breast Tumor in a Young Lady. Cureus 2023; 15:e37003. [PMID: 37139022 PMCID: PMC10150779 DOI: 10.7759/cureus.37003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Carcinosarcoma of the breast is a subtype of metaplastic breast carcinoma characterized by differentiation of the neoplastic epithelium toward mesenchymal-looking elements. It is a highly aggressive rare subtype of invasive breast neoplasm that exhibits a distinct histologic entity. Only a limited number of reports related to this type of disease have been reported. Here, we present a case of breast carcinosarcoma in a lady in her early 20s, which is relatively young among all cases published. It was challenging to achieve diagnosis preoperatively with histopathological evaluation of the ultrasound-guided tru-cut biopsy sample. With no evidence of distant metastasis clinically and radiologically, a surgical option was opted for. Left mastectomy and left chest wall reconstruction with deep inferior epigastric artery free flap were performed. Post-excision specimen was confirmed to be carcinosarcoma.
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6
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Talwar A, Patel E, Tam M, Zhou F, Hu K, Persky M, Vaezi A, Jacobson A, Givi B. Patterns of Care and Outcomes of Carcinosarcoma of the Major Salivary Glands. Otolaryngol Head Neck Surg 2023; 168:775-781. [PMID: 35998038 DOI: 10.1177/01945998221120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Carcinosarcoma of the salivary gland is a rare malignant biphasic tumor. The present study investigates the epidemiology and clinical behavior of carcinosarcoma of the major salivary glands using the National Cancer Database (NCDB). STUDY DESIGN Historical cohort study. SETTING NCDB. METHODS All tumors were selected between 2004 and 2018. Patient demographics, tumor characteristics, treatments, and survival were analyzed. Cox regression analysis was performed in surgically treated patients. RESULTS We identified 154 patients in the NCDB with carcinosarcoma of the salivary gland. Median age at diagnosis was 66 years (interquartile range, 55-76). Most patients were male (n = 92, 60%). The majority of tumors were in the parotid (n = 122, 79%), followed by submandibular gland (n = 21, 14%). The majority were high grade (n = 93, 95%), and a significant portion had locally advanced disease (pT3-4; n = 65, 62%). Nodal disease was present in more than one-third (n = 35, 36%). The most common treatment was surgery with adjuvant radiotherapy (n = 75, 49%). With a median follow-up of 36 months, the 3-year overall survival was 57.6% (95% CI, 48.7%-68.0%). In univariable analysis, advanced pT stage, pN+ disease, and positive margins were associated with worse survival. In multivariable analysis, age (hazard ratio, 1.02; 95% CI, 1.01-1.04; P = .03) and pT stage (hazard ratio, 2.51; 95% CI, 1.27-4.95; P = .008) remained significant. CONCLUSION Carcinosarcoma is a rare salivary gland tumor that frequently presents at a locally advanced stage. Despite multimodality treatments, the outcomes are poor. In the absence of clinical trial data, these data from the NCDB could guide clinicians in the management of this rare disease.
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Affiliation(s)
- Abhinav Talwar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evan Patel
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU Langone Health, New York City, New York, USA
| | - Fang Zhou
- Department of Pathology, NYU Langone Health, New York City, New York, USA
| | - Kenneth Hu
- Department of Radiation Oncology, NYU Langone Health, New York City, New York, USA
| | - Michael Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Alec Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
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7
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Vizgan N, Jokar TO, Enayati L, Salyana M, Gotlieb VK. Presentation and treatment of aggressive, Triple-Negative carcinosarcoma of the breast. Clin Case Rep 2022; 10:e6020. [PMID: 35865780 PMCID: PMC9291258 DOI: 10.1002/ccr3.6020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
An extremely rare form of breast cancer, breast carcinosarcoma accounts for less than a percent of all breast malignancies and is highly aggressive. Composed of both cancerous epithelial and mesenchymal cell types, breast carcinosarcoma is associated with a poor prognosis compared to more common breast cancers, and typically lack the receptors typical of other breast carcinomas, which minimize potential targets for treatment. In this case report, we discuss a 56-year-old patient affected by carcinosarcoma of the breast at a T2N1 stage, and the decision-making process that factored into her treatment plan.
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Affiliation(s)
- Niels Vizgan
- Department of ChemistryWesleyan UniversityMiddletownConnecticutUSA
| | | | - Ladan Enayati
- Department of Haematology/OncologyBrookdale University Hospital and Medical CenterBrooklynNew YorkUSA
| | - Muhammad Salyana
- Department of Haematology/OncologyBrookdale University Hospital and Medical CenterBrooklynNew YorkUSA
| | - Vladimir K. Gotlieb
- Department of Haematology/OncologyBrookdale University Hospital and Medical CenterBrooklynNew YorkUSA
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8
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Leão I, Afonso-João D, Esteves J, Fernandes F, Joaquim A. Metaplastic Breast Carcinoma in a 37-Year-Old Female: A Case Report. Cureus 2022; 14:e21881. [PMID: 35273849 PMCID: PMC8901166 DOI: 10.7759/cureus.21881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/12/2022] Open
Abstract
Metaplastic breast carcinoma (MBC) is a rare and aggressive histologic subtype of cancer. Because of its rarity and heterogeneity, the management of these patients is challenging. Here, we present the case of a rapidly progressive MBC with mesenchymal differentiation in a 37-year-old female, treated with trimodal therapy consisting of neoadjuvant chemotherapy with paclitaxel and carboplatin, followed by dose-dense cyclophosphamide and doxorubicin (ddAC), modified radical left mastectomy, and adjuvant radiotherapy. Despite the need to anticipate the surgery after the first cycle of ddAC, because of a life-treating adverse event, there was a pathologic complete response. Nevertheless, 6.2 months after completing adjuvant radiotherapy, the patient had a recurrence on the central nervous system (CNS) (two lesions), which was managed with excisional biopsy and stereotactic body radiation therapy. The patient also started “complementary” chemotherapy with capecitabine. Still, 18 months after being diagnosed, she died due to CNS disease progression.
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9
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Trapani D, Giugliano F, Uliano J, Zia VAA, Marra A, Viale G, Ferraro E, Esposito A, Criscitiello C, D'amico P, Curigliano G. Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review. Breast Cancer Res Treat 2021; 187:323-337. [PMID: 34043122 DOI: 10.1007/s10549-021-06259-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting. METHODS We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818). RESULTS We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min-max: 17-5142); median follow-up: 51 months (range: 21-268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients. CONCLUSIONS There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.
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Affiliation(s)
- D Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Giugliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - J Uliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - V A A Zia
- Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04037-004, Brazil
| | - A Marra
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Viale
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Ferraro
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - A Esposito
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - C Criscitiello
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - P D'amico
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy.
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10
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Sasamoto S, Aoki T, Tashiro Y, Matsuda K, Koizumi T, Kusano T, Wada Y, Shibata H, Tomioka K, Yamashita T, Date H, Ariyoshi T, Goto S, Yamazaki K, Fujimori A, Watanabe M, Enami Y, Otsuka K, Norose T, Ohike N, Yamochi T, Takimoto M, Murakami M. Experience of the pancreas duodenectomy for so-called carcinosarcoma of the common bile duct:a case report and review of literature. Int Cancer Conf J 2021; 10:134-138. [PMID: 33786287 DOI: 10.1007/s13691-020-00462-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
A 79-year-old man presented with malaise and jaundice at a local hospital. His blood tests showed severe inflammation, liver failure, and high expression of several tumour markers. Radiological findings revealed dilated common and intrahepatic bile ducts and a lower bile duct constricted by a soft tissue mass. Histological findings by endoscopy showed a suspected adenocarcinoma, which was determined as class IV by cytology. The patient was referred to our hospital for surgical treatment. He underwent pancreaticoduodenectomy and the final diagnosis was so-called carcinosarcoma of the bile duct. He had liver metastasis and died at 26 postoperative months.
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Affiliation(s)
- Suguru Sasamoto
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Takeshi Aoki
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Yoshihiko Tashiro
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Kazuhiro Matsuda
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Tomotake Koizumi
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Tomokazu Kusano
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Yusuke Wada
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Hideki Shibata
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Kodai Tomioka
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Takeshi Yamashita
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Hiromi Date
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Tomotake Ariyoshi
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Satoru Goto
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Kimiyasu Yamazaki
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Akira Fujimori
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Makoto Watanabe
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Yuta Enami
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Koji Otsuka
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Tomoko Norose
- Department of Diagnostic Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Nobuyuki Ohike
- Department of Diagnostic Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Toshiko Yamochi
- Department of Diagnostic Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Masafumi Takimoto
- Department of Diagnostic Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Masahiko Murakami
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
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Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma. World J Surg 2020; 44:3901-3914. [PMID: 32651603 DOI: 10.1007/s00268-020-05686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7. RESULTS A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 0.71 (p = 0.41) and 4.15 (p < 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 1.52 (p = 0.023) and 2.45 (p < 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI ≤ 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI ≥ 7 group (p = 0.053; ACCI ≤ 5 vs. = 6, p = 0.19; ACCI = 6 vs. ≥ 7, p < 0.001; ACCI ≤ 5 vs. ≥ 7). In terms of the treatment for HCC recurrence in ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. CONCLUSIONS The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.
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12
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Lin S, Liu C, Tao Z, Zhang J, Hu X. Clinicopathological characteristics and survival outcomes in breast carcinosarcoma: A SEER population-based study. Breast 2019; 49:157-164. [PMID: 31812891 PMCID: PMC7375547 DOI: 10.1016/j.breast.2019.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Carcinosarcoma of the breast is a rare disease. Its clinicopathological features and prognosis are not well defined. The aim of this study was to compare the clinicopathological features and clinical outcome between breast carcinosarcoma and breast invasive ductal carcinoma (IDC). MATERIALS AND METHODS Patients with breast carcinosarcoma and breast IDC were identified through the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Then a comparison was conducted between these two groups. Propensity score matching (PSM) was performed to balance the effects of baseline clinicopathological differences. The Cox proportional hazard model was used to identify potential prognostic factors of breast carcinosarcoma. RESULTS In total, we identified 63 patients with breast carcinosarcoma and 200,596 cases with breast IDC. Comparing with IDC, breast carcinosarcoma was significantly correlated with higher grading, higher staging, larger tumor size, lower lymph node involvement, and a higher proportion of triple negative breast cancer (TNBC), suggesting a significantly worse clinical outcome. After adjusting for the uneven clinicopathological variables with PSM, significant differences were still observed between these two histology types. Subgroup analysis further showed that carcinosarcoma-TNBC has an inferior clinical outcome compared with IDC-TNBC. Finally, we identified independent prognostic factors, namely, stage, tumor size, and distant metastasis. CONCLUSION It is concluded that breast carcinosarcoma has distinct clinicopathological features and a significantly worse clinical outcome than common IDC.
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Affiliation(s)
- Shuchen Lin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Chang Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Zhonghua Tao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China.
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13
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Kennedy WR, Gabani P, Acharya S, Thomas MA, Zoberi I. Clinical outcomes and patterns of care in the treatment of carcinosarcoma of the breast. Cancer Med 2019; 8:1379-1388. [PMID: 30864198 PMCID: PMC6488124 DOI: 10.1002/cam4.1942] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/20/2018] [Accepted: 12/01/2018] [Indexed: 12/27/2022] Open
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.
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Affiliation(s)
- William R Kennedy
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Sahaja Acharya
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
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