ArticleBreast cancer research and treatment2025
National trends and survival outcomes associated with non-guideline-concordant treatment of inflammatory breast cancer.
Article in Breast cancer research and treatment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeNational Comprehensive Cancer Network (NCCN) guidelines for inflammatory breast cancer (IBC) recommend trimodal therapy: neoadjuvant chemotherapy, modified radical mastectomy (MRM), and adjuvant radiation therapy. Historically, a minority received NCCN-guideline-concordant trimodal therapy (GCT). We explored factors associated with non-concordance, types of non-concordance, and the association of GCT with survival.
methodsThe National Cancer Database (NCDB) was analyzed for patients with non-metastatic IBC who underwent surgery from 2006 to 2019. Multivariate logistic regression identified factors associated with GCT. Cox proportional hazard models assessed the impact of GCT, and components of non-concordance, on mortality.
resultsOf 13,733 patients, 47.6% received GCT. Of non-GCT patients, 39.7% had mixed non-concordance, 25.5% exclusive chemotherapy non-concordance, 24.0% exclusive radiation non-concordance, and 10.8% exclusive surgical non-concordance. A higher burden of comorbidities, node-negative disease, and positive human epidermal growth factor receptor 2 (HER2) and hormone receptor status were associated with reduced odds of receiving GCT. GCT was associated with reduced 3-(hazard ratio [HR] = 0.83, 95% CI 0.73-0.95) and 5-year (HR = 0.83, 95% CI 0.76-0.91) mortality. Chemotherapy non-concordance and mixed non-concordance were associated with higher three-(HR = 1.28, 95% CI 1.07-1.53; HR = 1.20, 95% CI 1.01-1.43 respectively) and 5-year (HR = 1.42, 95% CI 1.26-1.60; HR = 1.17, 95% CI 1.03-1.33) mortality. Radiation non-concordance was associated with increased hazard of 1-year mortality (HR = 3.03, 95% CI 1.75-5.23). Exclusive surgical non-concordance was not associated with survival; however, simple mastectomy portended a higher hazard of 5-year mortality (HR = 1.26, 95% CI 1.08-1.46).
conclusionDespite improved survival, a minority of patients received GCT. Omitting neoadjuvant chemotherapy or adjuvant radiation was associated with reduced survival, whereas surgical non-concordance in patients with concordant chemoradiation did not impact survival. Simple mastectomy was associated with reduced survival, supporting the rationale for axillary lymphadenectomy.
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