Abstract P3-06-23: Primary breast sarcoma: Clinicopathological outcomes from the Philippine General Hospital and review of literature
Authors: Manalo MOU , Agana MAE , Fernando GY 
Published: August 2014

Primary sarcomas of the breast are extremely rare, with less than 0.1% of all malignant tumors of the breast. As of the present, there are 13 major breast sarcoma series in English literature, but the data provided by these reports has not been sufficiently informative to enhance our understanding of the natural history of this malignant growth, especially in the local setting. As a step in further understanding primary sarcomas of the breast in the Philippines, this study characterized the Filipino patient with primary breast sarcoma, excluding cystosarcoma phyllodes.

All breast biopsies from the UP-Philippine General Hospital Pathology records were searched for breast sarcoma cases from January 2000 to December 2010. Metaplastic carcinomas and phyllodes tumors were excluded. There were 52 patients (45 female, 7 male) ranging in age 25-83 years (median 46 years). Majority of the cases presented with lump, ten cases presented with pain. No history of previous cancer was elicited in any of the patients. No history of prior radiation was found in any case, therefore excluding postradiation sarcoma. Histopathological diagnoses were spindle cell sarcoma (n = 13), fibrosarcoma (n = 6), liposarcoma (n = 6), MPNST (n = 5), stromal sarcoma (n = 5), angiosarcoma (n = 4), MFH (n = 4), leiomyosarcoma (n = 3), rhabdomyosarcoma (n = 3), chondrosarcoma (n = 2), and synovial sarcoma (n = 1). Tumors were graded as grade 1 (n = 18), grade 2 (n = 8), and grade 3 (n = 10). Simple mastectomy was done in 19 cases (37%), MRM in 31 cases (59%), while 2 cases were deemed far advanced for any surgical intervention (3%). None of the patients were given adjuvant radiotherapy or chemotherapy. The duration of follow-up for 45 patients ranged between 1 month to 117 months. Fourteen deaths were related to tumor, whereas one was not. All patients with initially unresectable tumors died of their disease. Recurrences were observed in 9 patients.

The 3-year overall survival (OS) and disease-free survival (DFS) for the whole population was 75% and 73%, respectively.

Results of Univariate Analysis  3-year DFS  3-year OS  %HRp%HRpTUMOR SIZE      &gt;10 cm491.00-441.00-5-10 cm864.270.0260865.010.019&lt;5 cm783.200.158783.650.122GRADE      3401.00-321.00-2884.350.073884.030.09719110.480.0019118.640.001MARGIN STATUS      +671.00-501.00--771.810.575771.490.074TYPE OF SURGERY      SM751.00-74--MRM771.100.866771.080.901AGE      &gt;40 yrs old661.00-63--≤40 yrs old801.760.366791.710.387HISTOLOGY      Angiosarcoma01.00-0--Others8413.47&lt;0.0018411.03&lt;0.001

Tumor size (HR = 5.01; p = 0.019), tumor grade (HR = 18.64; p = 0.001), and breast sarcoma subtypes other than angiosarcoma (HR = 11.03; p&lt;0.001) were significantly associated with OS. On multivariate analysis, DFS and OS were significantly correlated with grade (HR = 20.73; p = 0.003 and HR = 39.57; p = 0.004) and breast sarcoma subtypes other than angiosarcoma (HR = 35.20; p = 0.005 and HR = 50.74; p = 0.007), respectively, while controlling for the confounding effect of clinically important factors such as age, size, margin, and type of surgery. In this series, there was no association between OS and surgical margins, type of surgery, and age of the patient. This is the first major primary breast sarcoma series in the Philippines.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-23.