Introduction: Metaplastic breast carcinomas are a rare, heterogeneous group\nof breast malignancies characterized by an intrinsically aggressive histology\nand an unfavorable prognosis. Objective: To determine the clinical and pathological\ncharacteristics of metaplastic breast cancers in Tunisian patients,\nand evaluate their impact on its evolution. Methods: A retrospective study of\n44 cases of metaplastic cancers archived during a 26-year period in the Cancer\nRegistry of the Tunisian Center. Results: The frequency of metaplastic\ncancer was 0.97%. Mean age at diagnosis was 55.4 years (range 26 - 84). Average\ntime to diagnosis was 5.5 months. Average clinical tumor size was 4.95\ncm (range 1.5 - 15). Axillary ipsilateral adenopathy was present at diagnosis\nin 45.9%. The clinical stages IIB (31.8%) and IIA (22.7%) predominated.\nSquamous metaplasia was the most common (68%) followed by the heterologous\nmesenchymal subtype. Ganglionic invasion was histologically proven\nin 17 cases, of which 77% had only adenocarcinomatous contingents. Absence\nof hormone receptor expression and HER2 overexpression predominated.\nPrimary surgery was carried out in 95% of cases. Average follow-up\nwas 40 months (range 2 - 135). Average overall survival (OS) was 74 months,\n63% at 5 years and 60% at 10 years. Average progression free survival (PFS)\nwas 29 months (range 3 - 129), 38% at 5 years and 32% at 10 years. Factors\nsignificantly influencing OS and PFS were histological lymph node involvement\n(p = 0.001 and p = 0.002 respectively). Conclusion: Metaplastic breast\ncancer observed in Tunisian women constitutes a histological type with an\nunfavorable prognosis whose improvement requires a more adapted therapeutic\nstrategy.
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