title: Chemotherapy response and survival of inflammatory breast cancer by hormone receptor- and HER2-defined molecular subtypes approximation: an analysis from the National Cancer Database.
abstract: OBJECTIVE
  To study the impact of hormone receptor (HR)- and human epidermal growth factor receptor 2 (HER2)-defined subtypes on survival of inflammatory breast cancer (IBC), and to determine whether sensitivity to neoadjuvant chemotherapy (NAC) varies with subtypes in a large IBC population.
  
  
  METHODS
  We analyzed 593 IBCs with known HR/HER2 statuses between 2010 and 2011 from National Cancer Database. We compared pathologic complete response (pCR) rates among four molecular subtypes by Chi-square test. Overall survival (OS) was compared among four subtypes and patients with or without pCR using log-rank test. Multivariate Cox model was performed to identify the impact of molecular subtype and other prognostic factors on OS.
  
  
  RESULTS
  Of the 593 patients included, 231 (39.0 %) patients had HR+/HER2- tumors, 98 (16.5 %) had HR+/HER2+ disease, 112 (18.9 %) were HR-/HER2 + patients, and 152 (25.6 %) had triple-negative subtype. The pCR rates differed significantly by subtype (P < 0.001): HR-/HER2+ showed the highest, and HR+/HER2- exhibited the lowest. Multivariate analysis showed that triple-negative and HR+/HER2- IBCs had significantly worse survival compared with HR+/HER2+ or HR-/HER2+ subtype (P < 0.01 for all comparisons). Additional factors associated with worse OS included more comorbidities, lack or incomplete surgical resection, absence of radiotherapy, lack of hormone therapy, and more advanced stage.
  
  
  CONCLUSIONS
  IBC is an aggressive heterogeneous disease with distinct molecular subtypes associated with differential outcomes and sensitivities to NAC. Unlike in noninflammatory breast cancer, in IBC HR + disease was not associated with favorable prognosis. Triple-negative and HR+/HER2- subtypes are independent predictors for suboptimal OS in IBC.
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang West Road 107#, Guangzhou, 510120, China. liujieqiong01@163.com.|Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Blalock 607, Baltimore, MD, 21287, USA. liujieqiong01@163.com.
authors.forename: Jieqiong
authors.initials: J
authors.lastname: Liu
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang West Road 107#, Guangzhou, 510120, China.|Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Blalock 607, Baltimore, MD, 21287, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of General Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Mao
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang West Road 107#, Guangzhou, 510120, China.
authors.forename: Shunrong
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang West Road 107#, Guangzhou, 510120, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Blalock 607, Baltimore, MD, 21287, USA. ljacob14@jhmi.edu.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Chemotherapy response; Inflammatory breast cancer; Molecular subtype; National Cancer Database; Overall survival