Highlights
- •Primary breast sarcoma was associated with better overall survival compared to secondary breast sarcoma.
- •About 60% of patients with secondary breast sarcoma received radiation for their primary tumors.
- •Surgery was associated with better overall survival for primary and secondary sarcoma patients.
- •Radiation and chemotherapy did not show significant improvement in survival of patients with primary and secondary breast sarcoma.
- •Factors associated with worse survival of patients with primary breast sarcoma included being unmarried, age > 60 years and tumor size > 50 mm.
- •The created and validated nomograms showed a good performance with C index of 0.71 for primary breast sarcoma and 0.69 for secondary breast sarcoma.
Abstract
Background
Breast sarcoma is one of the rare types of breast tumors with different features and
outcomes compared to carcinoma. Our study aims to describe the clinical and pathological
characteristics of primary breast sarcoma (PBS) and secondary breast sarcoma (SBS)
along with determining prognostic factors and developing nomograms for predicting
survival.
Methods
Using the Surveillance, Epidemiology, and End Results (SEER) Program, female patients
diagnosed with breast sarcoma between 1975 and 2016 were identified. Cox regression
was used to evaluate the association between survival and clinical features.
Results
Out of 1334 included patients, 816 had PBS and 518 had SBS. PBS had a significantly
better overall survival than SBS with median survival months of 107 for PBS and 45
for SBS. The primary tumor site did not have a significant impact on the survival
of SBS. Cox regression showed worse survival of PBS patients who were > 60 years (HR
3.04, 95% CI 2.46-3.74) and had tumor size > 50 mm (HR 2.01, 95% CI 1.61-2.51). Being
not married was associated with worse survival of PBS (HR 1.29, 95% CI 1.06-1.56)
and SBS (HR 1.50, 95% CI 1.19-1.90). Surgery was associated with better survival of
PBS (HR 0.60, 95% CI 0.42-0.85) and SBS (HR 0.46, 95% CI 0.31-0.68). The C-indexes
of created nomograms were 0.73 for PBS and 0.69 for SBS.
Conclusion
Age and size were the most important prognostic factors for the survival. Surgery
was associated with better survival. However, radiation and chemotherapy did not show
significant improvement in survival.
Keywords
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References
- An analysis of 78 breast sarcoma patients without distant metastases at presentation.Int J Radiat Oncol Biol Phys. 2000; 46: 383-390https://doi.org/10.1016/S0360-3016(99)00444-7
- Prognostic factors in primary breast sarcomas: a series of patients with long-term follow-up.J Clin Oncol. 2003; 21: 2583-2588https://doi.org/10.1200/JCO.2003.06.080
- Primary female breast sarcoma: clinicopathological features, treatment and prognosis.Sci Rep. 2016; 6https://doi.org/10.1038/SREP31497
- Sarcoma of the breast: clinical characteristics and outcomes of 991 patients from the national cancer database.Sarcoma. 2021; : 2021https://doi.org/10.1155/2021/8828158
- Primary and secondary breast angiosarcoma: single center report and a meta-analysis.Breast Cancer Res Treat. 2019; 178: 523-533https://doi.org/10.1007/S10549-019-05432-4
- Soft tissue sarcoma after treatment for breast cancer.Radiother Oncol. 1996; 38: 25-31https://doi.org/10.1016/0167-8140(95)01663-5
- Sarcoma as a second malignancy after treatment for breast cancer.Int J Radiat Oncol Biol Phys. 2002; 52: 1231-1237https://doi.org/10.1016/S0360-3016(01)02799-7
- Role of radiotherapy in sarcoma of the breast–a retrospective review of the M.D. Anderson experience.Radiother Oncol. 1999; 52: 173-178https://doi.org/10.1016/S0167-8140(99)00070-5
- Primary and secondary angiosarcoma of the breast: the Mayo Clinic experience.J Surg Oncol. 2010; 101: 401-407https://doi.org/10.1002/JSO.21497
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Custom Data (with additional treatment fields), Nov 2018 Sub (1975-2016 varying) - Linked To County Attributes - Total U.S., 1969.
- Human breast sarcoma and human breast implantation: A time trend analysis based on SEER data (1973-1990).J Clin Epidemiol. 1995; 48: 539-544https://doi.org/10.1016/0895-4356(94)00210-H
- Prognosis and treatment of non-metastatic primary and secondary breast angiosarcoma: a comparative study.BMC Cancer. 2017; 17: 1-8https://doi.org/10.1186/S12885-017-3292-7/TABLES/3
- Primary and secondary angiosarcoma of the breast.Gland Surgery. 2014; 3: 28https://doi.org/10.3978/J.ISSN.2227-684X.2013.12.03
- Angiosarcoma of the breast: a difficult surgical challenge.Breast. 2012; 21: 584-589https://doi.org/10.1016/J.BREAST.2012.01.001
- Sarcoma as a second malignancy after treatment for breast cancer.Int J Radiat Oncol Biol Phys. 2002; 52: 1231-1237https://doi.org/10.1016/S0360-3016(01)02799-7
- The risk of angiosarcoma following primary breast cancer.Br J Cancer. 1999; 81: 532https://doi.org/10.1038/SJ.BJC.6690726
- Angiosarcoma after radiotherapy: a cohort study of 332 163 Finnish cancer patients.Br J Cancer. 2007; 97: 115https://doi.org/10.1038/SJ.BJC.6603805
- Radiation-induced sarcoma of the breast: a systematic review.Oncologist. 2012; 17: 405https://doi.org/10.1634/THEONCOLOGIST.2011-0282
- Angiosarcoma after breast-conserving therapy: fine-needle aspiration biopsy, immunocytochemistry, and clinicopathologic correlates.Cancer. 2005; 105: 145-151https://doi.org/10.1002/CNCR.21035
- Primary nonphylloides breast sarcomas.Am J Surg. 2003; 186: 359-361https://doi.org/10.1016/S0002-9610(03)00269-1
- Outcome and prognostic factors in breast sarcoma: a multicenter study from the rare cancer network.Radiother Oncol. 2007; 85: 355-361https://doi.org/10.1016/J.RADONC.2007.10.015
- An analysis of 78 breast sarcoma patients without distant metastases at presentation.Int J Radiat Oncol Biol Phys. 2000; 46: 383-390https://doi.org/10.1016/S0360-3016(99)00444-7
- Neoadjuvant chemotherapy for primary sarcoma of the breast: a case report.J Med Case Rep. 2019; 13: 1-6https://doi.org/10.1186/S13256-019-2197-2/TABLES/1
- Sarcomas and malignant phyllodes tumours of the breast – a retrospective study.Eur J Cancer. 2006; 42: 2715-2721https://doi.org/10.1016/J.EJCA.2006.05.040
- Primary nonphylloides breast sarcomas.Am J Surg. 2003; 186: 359-361https://doi.org/10.1016/S0002-9610(03)00269-1
- Surgical management of primary breast sarcoma.Am Surg. 2002; 68: 673-677
- Diagnosis and management of primary breast sarcoma.Breast Cancer Res Treat. 2010; 122: 619-626https://doi.org/10.1007/S10549-010-0915-Y/TABLES/2
- marital status and survival in patients with cancer.J Clin Oncol. 2013; 31: 3869https://doi.org/10.1200/JCO.2013.49.6489
- The effect of marital status on breast cancer-related outcomes in women under 65: a SEER database analysis.Breast. 2017; 32: 13-17https://doi.org/10.1016/J.BREAST.2016.12.008
- Effects of marital status on breast cancer survival by age, race, and hormone receptor status: a population-based Study.Cancer Med. 2019; 8: 4906https://doi.org/10.1002/CAM4.2352
- Primary and secondary angiosarcomas: a comparative single-center analysis.Clin Sarcoma Res. 2015; 5https://doi.org/10.1186/s13569-015-0028-9
- Postoperative nomogram for survival of patients with retroperitoneal sarcoma treated with curative intent.Ann Oncol. 2010; 21: 397-402https://doi.org/10.1093/ANNONC/MDP298
- Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis.Lancet Oncol. 2016; 17: 671-680https://doi.org/10.1016/S1470-2045(16)00010-3
Article Info
Publication History
Published online: July 22, 2022
Accepted:
July 17,
2022
Received in revised form:
June 15,
2022
Received:
April 11,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
