Carcinosarcoma of the breast is a rare and aggressive type of breast cancer presenting as a high grade tumour with lower rates of both lymph node metastasis and oestrogen and progesterone receptor (ER/PR) expression when compared to the more common types of breast cancer, carrying a less favourable prognosis. We present the clinical and pathological findings and outcomes of a series of patients diagnosed and treated for breast carcinosarcoma at a UK specialist cancer centre.
We conducted a retrospective review of data for all patients diagnosed with breast carcinosarcoma between October 2004 and October 2014 at the Clatterbridge Cancer Centre NHS Foundation Trust.
Nine patients were diagnosed in the 10-year period, with a median age at diagnosis of 73 years (range 37-76 years). Seven patients (77.8%) were postmenopausal. Six patients (66.7%) presented with a palpable mass. T1, T2, and T3 were found in 1, 6 and 2 patients respectively. N0, N1, and N2 were found in 6, 2 and 1 patients respectively. All patients had G3 disease with a median diameter of 3cm (range 1.9-9.0 cm). Oestrogen receptor (ER) and progesterone receptor (PR) were both negative in 8 patients (88.9%). Whilst one patient had wide local excision, all the rest had mastectomy, of whom 4 had axillary nodal clearance and 4 had sentinel nodal biopsy. Five patients received adjuvant radiotherapy. Adjuvant chemotherapy was delivered to 5 patients (2 patients received neither treatments) and adjuvant hormone therapy was delivered to 2 patients (one of whom had a concurrent contralateral ER/PR positive tumour). Patients were followed up for a median period of 15 months (range 1-60 months). Median DFS is estimated to be 25 months and median OS is estimated to be 49 months (95% CI: 14-84 months). Two patients (22.2%) developed metastases with a DFS time of 13 and 14 months respectively, and both died within 5 months.
Within a 10 year period during which our specialist cancer centre were referred 16,500 new breast cancer patients, only 9 patients had carcinosarcoma. Prognosis following recurrence is poor within our limited cohort, in agreement with the published literature. In order for more meaningful analysis of survival outcomes for such a rare form of breast cancer, a multicentre collaborative approach is required.
Clinical trial identification
Legal entity responsible for the study
Clatterbridge Cancer Centre
All authors have declared no conflicts of interest.