Research development of metaplastic breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaolu ^1,2 ,  WANG Jing ¹

1. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China Medical School of Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Jing, Email: wangjing2341@126.com

Keywords：

metaplastic breast cancer; clinical manifestation; diagnosis; treatment; prognosis; pathogenesis

DOI：

10.7507/1007-9424.201711046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of metaplastic breast cancer (MBC), and to provide some new ideas for clinical diagnosis and treatment, and exploration of scientific research for it. Method The relevant literatures of the latest research on MBC were reviewed and analyzed. Results At present, the pathogenesis of the MBC was still uncertain. The incidence of the MBC was lower, and it’s clinical manifestations were not specific. Compared with the invasive breast cancer, the tumor diameter was larger, the growth was faster, the differentiation degree was lower, the risks of the local and distant metastases were higher, while the lymph node metastasis was rare. Because of the clinical manifestation, auxiliary examination, and imaging examinations were lack of specificity, the diagnosis was difficult. Although the preoperative puncture could provide a reliable diagnosis evidence, it was difficult for distinguishing and accurate diagnosis due to it’s more subtypings. Some of the specific molecular targets could provide a help for it. At present, the modified radical mastectomy was often performed, the axillary lymph node metastasis was relatively rare in the MBC, so the sentinel lymph node biopsy was more important in the treatment of the MBC. The therapeutic effect was limited by the endocrine therapy, targeted therapy, or neoadjuvant chemotherapy and was poor by the systemic chemotherapy. Although the radiotherapy and chemotherapy could improve the overall survival and prolong the disease-free survival and control the local recurrence, the difference of it’s therapeutic effect was great due to the complex MBC typing. Conclusions MBC is a highly malignant and strongly invasive tumor, and it has more subtypings. Clinical manifestation and preoperative examination are lack of specificity, hence it is easy for misdiagnosis or missed diagnosis. Unified treatment guideline is lack of, prognosis is poor. So, it needs to explore some new treatment methods and formulate standardized treatment guidelines in order to achieve a better therapeutic effect.

Citation： WANG Xiaolu, WANG Jing. Research development of metaplastic breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 761-766. doi: 10.7507/1007-9424.201711046 Copy

1.	Paul Wright G, Davis AT, Koehler TJ, et al. Hormone receptor status does not affect prognosis in metaplastic breast cancer: a population-based analysis with comparison to infiltrating ductal and lobular carcinomas. Ann Surg Oncol, 2014, 21(11): 3497-3503.
2.	Huvos AG, Lucas JC Jr, Foote FW Jr. Metaplastic breast carcinoma. Rare form of mammary cancer. N Y State J Med, 1973, 73(9): 1078-1082.
3.	Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization, 2000.
4.	Aydiner A, Sen F, Tambas M, et al. Metaplastic breast carcinoma versus triple-negative breast cancer: survival and response to treatment. Medicine (Baltimore), 2015, 94(52): e2341.
5.	丁華野, 皋嵐湘. 化生性乳腺癌的診斷和鑒別診斷. 浙江腫瘤, 1996, 2(4): 199-202.
6.	The World Health Organization. Histological typing of breast tumors. Neoplasma, 1983, 30(1): 113-123.
7.	Lakhani SR, Ellis IO, Schnitt SJ, et al. WHO classification of tumours of the breast. 4th ed. Geneva: World Health Organization, 2012.
8.	Abd El hafez A, Abd El-aty S. Analysis of metaplastic breast carcinoma: FNAC; histopathology and immunohistochemistry are complementary for diagnosis. Breast Dis, 2013, 34(2): 67-75.
9.	Abouharb S, Moulder S. Metaplastic breast cancer: clinical overview and molecular aberrations for potential targeted therapy. Curr Oncol Rep, 2015, 17(3): 431.
10.	Dieci MV, Orvieto E, Dominici M, et al. Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist, 2014, 19(8): 805-813.
11.	Myint ZW, Raparla S, Kamugisha LK. Metaplastic breast cancer with chondroid differentiation. J Community Hosp Intern Med Perspect, 2015, 5(4): 28935.
12.	Schwartz TL, Mogal H, Papageorgiou C, et al. Metaplastic breast cancer: histologic characteristics, prognostic factors and systemic treatment strategies. Exp Hematol Oncol, 2013, 2(1): 31.
13.	Zhang Y, Toy KA, Kleer CG. Metaplastic breast carcinomas are enriched in markers of tumor-initiating cells and epithelial to mesenchymal transition. Mod Pathol, 2012, 25(2): 178-184.
14.	Leibl S, Gogg-Kammerer M, Sommersacher A, et al. Metaplastic breast carcinomas: are they of myoepithelial differentiation?: immunohistochemical profile of the sarcomatoid subtype using novel myoepithelial markers. Am J Surg Pathol, 2005, 29(3): 347-353.
15.	Cooper CL, Karim RZ, Selinger C, et al. Molecular alterations in metaplastic breast carcinoma. J Clin Pathol, 2013, 66(6): 522-528.
16.	Lorenzatti G, Huang W, Pal A, et al. CCN6 (WISP3) decreases ZEB1-mediated EMT and invasion by attenuation of IGF-1 receptor signaling in breast cancer. J Cell Sci, 2011, 124(Pt 10): 1752-1758.
17.	高月, 魯亞晶, 苗楊, 等. Snail 和 E-cad 在化生性乳腺癌中的表達及其臨床意義. 臨床腫瘤學雜志, 2015, 20(9): 799-803.
18.	Liu YN, Lee WW, Wang CY, et al. Regulatory mechanisms controlling human E-cadherin gene expression. Oncogene, 2005, 24(56): 8277-8290.
19.	Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol, 2015, 26(8): 1533-1546.
20.	Reis-Filho JS, Milanezi F, Steele D, et al. Metaplastic breast carcinomas are basal-like tumours. Histopathology, 2006, 49(1): 10-21.
21.	Reis-Filho JS, Tutt AN. Triple negative tumours: a critical review. Histopathology, 2008, 52(1): 108-118.
22.	Lim KH, Oh DY, Chie EK, et al. Metaplastic breast carcinoma: clinicopathologic features and prognostic value of triple negativity. Jpn J Clin Oncol, 2010, 40(2): 112-118.
23.	Rakha EA, Elsheikh SE, Aleskandarany MA, et al. Triple-negative breast cancer: distinguishing between basal and nonbasal subtypes. Clin Cancer Res, 2009, 15(7): 2302-2310.
24.	Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors? J Clin Pathol, 2005, 58(7): 700-704.
25.	Min Kim H, Kim SK, Jung WH, et al. Metaplastic carcinoma show different expression pattern of YAP compared to triple-negative breast cancer. Tumour Biol, 2015, 36(2): 1207-1212.
26.	Leo F, Bartels S, M?gel L, et al. Prognostic factors in the myoepithelial-like spindle cell type of metaplastic breast cancer. Virchows Arch, 2016, 469(2): 191-201.
27.	Wang H, Guan B, Shi Q, et al. May metaplastic breast carcinomas be actually basal-like carcinoma? Further evidence study with its ultrastructure and survival analysis. Med Oncol, 2011, 28(1): 42-50.
28.	Kuroda N, Fujishima N, Inoue K, et al. Basal-like carcinoma of the breast: further evidence of the possibility that most metaplastic carcinomas may be actually basal-like carcinomas. Med Mol Morphol, 2008, 41(2): 117-120.
29.	Sanguinetti A, Lucchini R, Santoprete S, et al. Metaplastic carcinoma of the breast: Treatment, results and prognostic factors based on international literature. Ann Ital Chir, 2014, 85(2): 109-113.
30.	Salimo?lu S, Sert ?, Emiro?lu M, et al. Metaplastic breast carcinoma: analysis of clinical and pathologic characteristics—a case series. J Breast Health, 2016, 12(2): 63-66.
31.	Terando AM, Agnese DM, Holmes DR. Treatment and prognosis of rare breast cancers. Ann Surg Oncol, 2015, 22(10): 3225-3229.
32.	Luini A, Aguilar M, Gatti G, et al. Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat, 2007, 101(3): 349-353.
33.	Günhan-Bilgen I, Memi? A, Ustün EE, et al. Metaplastic carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation. AJR Am J Roentgenol, 2002, 178(6): 1421-1425.
34.	Arpino G, Clark GM, Mohsin S, et al. Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome. Cancer, 2002, 94(8): 2119-2127.
35.	Velasco M, Santamaría G, Ganau S, et al. MRI of metaplastic carcinoma of the breast. AJR Am J Roentgenol, 2005, 184(4): 1274-1278.
36.	Leyrer CM, Berriochoa CA, Agrawal S, et al. Predictive factors on outcomes in metaplastic breast cancer. Breast Cancer Res Treat, 2017, 165(3): 499-504.
37.	Zhang Y, Lv F, Yang Y, et al. Clinicopathological features and prognosis of metaplastic breast carcinoma: experience of a major chinese cancer center. PLoS One, 2015, 10(6): e0131409.
38.	Creighton CJ, Chang JC, Rosen JM. Epithelial-mesenchymal transition (EMT) in tumor-initiating cells and its clinical implications in breast cancer. J Mammary Gland Biol Neoplasia, 2010, 15(2): 253-260.
39.	Xiao M, Yang Z, Tang X, et al. Clinicopathological characteristics and prognosis of metaplastic carcinoma of the breast. Oncol Lett, 2017, 14(2): 1971-1978.
40.	Tanabe Y, Tsuda H, Yoshida M, et al. Pathological features of triple-negative breast cancers that showed progressive disease during neoadjuvant chemotherapy. Cancer Sci, 2017, 108(7): 1520-1529.
41.	Swathy PU, Arunalatha P, Chandramouleeswari K, et al. Adenosquamous variant of metaplastic carcinoma of breast—an unusual histological variant. J Clin Diagn Res, 2015, 9(2): E5-E6.
42.	Khan HN, Wyld L, Dunne B, et al. Spindle cell carcinoma of the breast: a case series of a rare histological subtype. Eur J Surg Oncol, 2003, 29(7): 600-603.
43.	Zhou N, Liu C, Hou H, et al. Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma. Oncotarget, 2016, 7(44): 72373-72379.
44.	Huang W, Pal A, Kleer CG. On how CCN6 suppresses breast cancer growth and invasion. J Cell Commun Signal, 2012, 6(1): 5-10.
45.	Martin EE, Huang W, Anwar T, et al. MMTV-cre;Ccn6 knockout mice develop tumors recapitulating human metaplastic breast carcinomas. Oncogene, 2017, 36(16): 2275-2285.
46.	Dave B, Granados-Principal S, Zhu R, et al. Targeting RPL39 and MLF2 reduces tumor initiation and metastasis in breast cancer by inhibiting nitric oxide synthase signaling. Proc Natl Acad Sci U S A, 2014, 111(24): 8838-8843.
47.	Dave B, Gonzalez DD, Liu ZB, et al. Role of RPL39 in metaplastic breast cancer. J Natl Cancer Inst, 2016, 109(6). pii: djw292.
48.	Francisco LM, Sage PT, Sharpe AH. The PD-1 pathway in tolerance and autoimmunity. Immunol Rev, 2010, 236: 219-242.
49.	Joneja U, Vranic S, Swensen J, et al. Comprehensive profiling of metaplastic breast carcinomas reveals frequent overexpression of programmed death-ligand 1. J Clin Pathol, 2017, 70(3): 255-259.
50.	Soliman H, Khalil F, Antonia S. PD-L1 expression is increased in a subset of basal type breast cancer cells. PLoS One, 2014, 9(2): e88557.
51.	Adams S. Dramatic response of metaplastic breast cancer to chemo-immunotherapy. NPJ Breast Cancer, 2017, 3: 8.
52.	Moreno-Bueno G, Portillo F, Cano A. Transcriptional regulation of cell polarity in EMT and cancer. Oncogene, 2008, 27(55): 6958-6969.
53.	Tampakis A, Tampaki EC, Trafalis D, et al. Nestin and CD146 expression in metaplastic breast cancer: stem-cell therapy in need? Lessons reported from a male patient. Eur Rev Med Pharmacol Sci, 2017, 21(18): 4137-4140.
54.	Asaduzzaman M, Constantinou S, Min H, et al. Tumour suppressor EP300, a modulator of paclitaxel resistance and stemness, is downregulated in metaplastic breast cancer. Breast Cancer Res Treat, 2017, 163(3): 461-474.
55.	Edenfield J, Schammel C, Collins J, et al. Metaplastic breast cancer: molecular typing and identification of potential targeted therapies at a single institution. Clin Breast Cancer, 2017, 17(1): e1-e10.
56.	Zhang X, Zhang B, Zang F, et al. Clinical features and treatment of squamous cell carcinoma of the breast. Onco Targets Ther, 2016, 9: 3181-3185.
57.	Rakha EA, Tan PH, Varga Z, et al. Prognostic factors in metaplastic carcinoma of the breast: a multi-institutional study. Br J Cancer, 2015, 112(2): 283-289.
58.	El Zein D, Hughes M, Kumar S, et al. Metaplastic carcinoma of the breast is more aggressive than triple-negative breast cancer: a study from a single institution and review of literature. Clin Breast Cancer, 2017, 17(5): 382-391.
59.	Lee H, Jung SY, Ro JY, et al. Metaplastic breast cancer: clinicopathological features and its prognosis. J Clin Pathol, 2012, 65(5): 441-446.
60.	Song Y, Liu X, Zhang G, et al. Unique clinicopathological features of metaplastic breast carcinoma compared with invasive ductal carcinoma and poor prognostic indicators. World J Surg Oncol, 2013, 11: 129.

1. Paul Wright G, Davis AT, Koehler TJ, et al. Hormone receptor status does not affect prognosis in metaplastic breast cancer: a population-based analysis with comparison to infiltrating ductal and lobular carcinomas. Ann Surg Oncol, 2014, 21(11): 3497-3503.
2. Huvos AG, Lucas JC Jr, Foote FW Jr. Metaplastic breast carcinoma. Rare form of mammary cancer. N Y State J Med, 1973, 73(9): 1078-1082.
3. Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization, 2000.
4. Aydiner A, Sen F, Tambas M, et al. Metaplastic breast carcinoma versus triple-negative breast cancer: survival and response to treatment. Medicine (Baltimore), 2015, 94(52): e2341.
5. 丁華野, 皋嵐湘. 化生性乳腺癌的診斷和鑒別診斷. 浙江腫瘤, 1996, 2(4): 199-202.
6. The World Health Organization. Histological typing of breast tumors. Neoplasma, 1983, 30(1): 113-123.
7. Lakhani SR, Ellis IO, Schnitt SJ, et al. WHO classification of tumours of the breast. 4th ed. Geneva: World Health Organization, 2012.
8. Abd El hafez A, Abd El-aty S. Analysis of metaplastic breast carcinoma: FNAC; histopathology and immunohistochemistry are complementary for diagnosis. Breast Dis, 2013, 34(2): 67-75.
9. Abouharb S, Moulder S. Metaplastic breast cancer: clinical overview and molecular aberrations for potential targeted therapy. Curr Oncol Rep, 2015, 17(3): 431.
10. Dieci MV, Orvieto E, Dominici M, et al. Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist, 2014, 19(8): 805-813.
11. Myint ZW, Raparla S, Kamugisha LK. Metaplastic breast cancer with chondroid differentiation. J Community Hosp Intern Med Perspect, 2015, 5(4): 28935.
12. Schwartz TL, Mogal H, Papageorgiou C, et al. Metaplastic breast cancer: histologic characteristics, prognostic factors and systemic treatment strategies. Exp Hematol Oncol, 2013, 2(1): 31.
13. Zhang Y, Toy KA, Kleer CG. Metaplastic breast carcinomas are enriched in markers of tumor-initiating cells and epithelial to mesenchymal transition. Mod Pathol, 2012, 25(2): 178-184.
14. Leibl S, Gogg-Kammerer M, Sommersacher A, et al. Metaplastic breast carcinomas: are they of myoepithelial differentiation?: immunohistochemical profile of the sarcomatoid subtype using novel myoepithelial markers. Am J Surg Pathol, 2005, 29(3): 347-353.
15. Cooper CL, Karim RZ, Selinger C, et al. Molecular alterations in metaplastic breast carcinoma. J Clin Pathol, 2013, 66(6): 522-528.
16. Lorenzatti G, Huang W, Pal A, et al. CCN6 (WISP3) decreases ZEB1-mediated EMT and invasion by attenuation of IGF-1 receptor signaling in breast cancer. J Cell Sci, 2011, 124(Pt 10): 1752-1758.
17. 高月, 魯亞晶, 苗楊, 等. Snail 和 E-cad 在化生性乳腺癌中的表達及其臨床意義. 臨床腫瘤學雜志, 2015, 20(9): 799-803.
18. Liu YN, Lee WW, Wang CY, et al. Regulatory mechanisms controlling human E-cadherin gene expression. Oncogene, 2005, 24(56): 8277-8290.
19. Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol, 2015, 26(8): 1533-1546.
20. Reis-Filho JS, Milanezi F, Steele D, et al. Metaplastic breast carcinomas are basal-like tumours. Histopathology, 2006, 49(1): 10-21.
21. Reis-Filho JS, Tutt AN. Triple negative tumours: a critical review. Histopathology, 2008, 52(1): 108-118.
22. Lim KH, Oh DY, Chie EK, et al. Metaplastic breast carcinoma: clinicopathologic features and prognostic value of triple negativity. Jpn J Clin Oncol, 2010, 40(2): 112-118.
23. Rakha EA, Elsheikh SE, Aleskandarany MA, et al. Triple-negative breast cancer: distinguishing between basal and nonbasal subtypes. Clin Cancer Res, 2009, 15(7): 2302-2310.
24. Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors? J Clin Pathol, 2005, 58(7): 700-704.
25. Min Kim H, Kim SK, Jung WH, et al. Metaplastic carcinoma show different expression pattern of YAP compared to triple-negative breast cancer. Tumour Biol, 2015, 36(2): 1207-1212.
26. Leo F, Bartels S, M?gel L, et al. Prognostic factors in the myoepithelial-like spindle cell type of metaplastic breast cancer. Virchows Arch, 2016, 469(2): 191-201.
27. Wang H, Guan B, Shi Q, et al. May metaplastic breast carcinomas be actually basal-like carcinoma? Further evidence study with its ultrastructure and survival analysis. Med Oncol, 2011, 28(1): 42-50.
28. Kuroda N, Fujishima N, Inoue K, et al. Basal-like carcinoma of the breast: further evidence of the possibility that most metaplastic carcinomas may be actually basal-like carcinomas. Med Mol Morphol, 2008, 41(2): 117-120.
29. Sanguinetti A, Lucchini R, Santoprete S, et al. Metaplastic carcinoma of the breast: Treatment, results and prognostic factors based on international literature. Ann Ital Chir, 2014, 85(2): 109-113.
30. Salimo?lu S, Sert ?, Emiro?lu M, et al. Metaplastic breast carcinoma: analysis of clinical and pathologic characteristics—a case series. J Breast Health, 2016, 12(2): 63-66.
31. Terando AM, Agnese DM, Holmes DR. Treatment and prognosis of rare breast cancers. Ann Surg Oncol, 2015, 22(10): 3225-3229.
32. Luini A, Aguilar M, Gatti G, et al. Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat, 2007, 101(3): 349-353.
33. Günhan-Bilgen I, Memi? A, Ustün EE, et al. Metaplastic carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation. AJR Am J Roentgenol, 2002, 178(6): 1421-1425.
34. Arpino G, Clark GM, Mohsin S, et al. Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome. Cancer, 2002, 94(8): 2119-2127.
35. Velasco M, Santamaría G, Ganau S, et al. MRI of metaplastic carcinoma of the breast. AJR Am J Roentgenol, 2005, 184(4): 1274-1278.
36. Leyrer CM, Berriochoa CA, Agrawal S, et al. Predictive factors on outcomes in metaplastic breast cancer. Breast Cancer Res Treat, 2017, 165(3): 499-504.
37. Zhang Y, Lv F, Yang Y, et al. Clinicopathological features and prognosis of metaplastic breast carcinoma: experience of a major chinese cancer center. PLoS One, 2015, 10(6): e0131409.
38. Creighton CJ, Chang JC, Rosen JM. Epithelial-mesenchymal transition (EMT) in tumor-initiating cells and its clinical implications in breast cancer. J Mammary Gland Biol Neoplasia, 2010, 15(2): 253-260.
39. Xiao M, Yang Z, Tang X, et al. Clinicopathological characteristics and prognosis of metaplastic carcinoma of the breast. Oncol Lett, 2017, 14(2): 1971-1978.
40. Tanabe Y, Tsuda H, Yoshida M, et al. Pathological features of triple-negative breast cancers that showed progressive disease during neoadjuvant chemotherapy. Cancer Sci, 2017, 108(7): 1520-1529.
41. Swathy PU, Arunalatha P, Chandramouleeswari K, et al. Adenosquamous variant of metaplastic carcinoma of breast—an unusual histological variant. J Clin Diagn Res, 2015, 9(2): E5-E6.
42. Khan HN, Wyld L, Dunne B, et al. Spindle cell carcinoma of the breast: a case series of a rare histological subtype. Eur J Surg Oncol, 2003, 29(7): 600-603.
43. Zhou N, Liu C, Hou H, et al. Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma. Oncotarget, 2016, 7(44): 72373-72379.
44. Huang W, Pal A, Kleer CG. On how CCN6 suppresses breast cancer growth and invasion. J Cell Commun Signal, 2012, 6(1): 5-10.
45. Martin EE, Huang W, Anwar T, et al. MMTV-cre;Ccn6 knockout mice develop tumors recapitulating human metaplastic breast carcinomas. Oncogene, 2017, 36(16): 2275-2285.
46. Dave B, Granados-Principal S, Zhu R, et al. Targeting RPL39 and MLF2 reduces tumor initiation and metastasis in breast cancer by inhibiting nitric oxide synthase signaling. Proc Natl Acad Sci U S A, 2014, 111(24): 8838-8843.
47. Dave B, Gonzalez DD, Liu ZB, et al. Role of RPL39 in metaplastic breast cancer. J Natl Cancer Inst, 2016, 109(6). pii: djw292.
48. Francisco LM, Sage PT, Sharpe AH. The PD-1 pathway in tolerance and autoimmunity. Immunol Rev, 2010, 236: 219-242.
49. Joneja U, Vranic S, Swensen J, et al. Comprehensive profiling of metaplastic breast carcinomas reveals frequent overexpression of programmed death-ligand 1. J Clin Pathol, 2017, 70(3): 255-259.
50. Soliman H, Khalil F, Antonia S. PD-L1 expression is increased in a subset of basal type breast cancer cells. PLoS One, 2014, 9(2): e88557.
51. Adams S. Dramatic response of metaplastic breast cancer to chemo-immunotherapy. NPJ Breast Cancer, 2017, 3: 8.
52. Moreno-Bueno G, Portillo F, Cano A. Transcriptional regulation of cell polarity in EMT and cancer. Oncogene, 2008, 27(55): 6958-6969.
53. Tampakis A, Tampaki EC, Trafalis D, et al. Nestin and CD146 expression in metaplastic breast cancer: stem-cell therapy in need? Lessons reported from a male patient. Eur Rev Med Pharmacol Sci, 2017, 21(18): 4137-4140.
54. Asaduzzaman M, Constantinou S, Min H, et al. Tumour suppressor EP300, a modulator of paclitaxel resistance and stemness, is downregulated in metaplastic breast cancer. Breast Cancer Res Treat, 2017, 163(3): 461-474.
55. Edenfield J, Schammel C, Collins J, et al. Metaplastic breast cancer: molecular typing and identification of potential targeted therapies at a single institution. Clin Breast Cancer, 2017, 17(1): e1-e10.
56. Zhang X, Zhang B, Zang F, et al. Clinical features and treatment of squamous cell carcinoma of the breast. Onco Targets Ther, 2016, 9: 3181-3185.
57. Rakha EA, Tan PH, Varga Z, et al. Prognostic factors in metaplastic carcinoma of the breast: a multi-institutional study. Br J Cancer, 2015, 112(2): 283-289.
58. El Zein D, Hughes M, Kumar S, et al. Metaplastic carcinoma of the breast is more aggressive than triple-negative breast cancer: a study from a single institution and review of literature. Clin Breast Cancer, 2017, 17(5): 382-391.
59. Lee H, Jung SY, Ro JY, et al. Metaplastic breast cancer: clinicopathological features and its prognosis. J Clin Pathol, 2012, 65(5): 441-446.
60. Song Y, Liu X, Zhang G, et al. Unique clinicopathological features of metaplastic breast carcinoma compared with invasive ductal carcinoma and poor prognostic indicators. World J Surg Oncol, 2013, 11: 129.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research development of metaplastic breast cancer

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