Hypothesis: "Up-front" surgery improves survival in inflammatory breast cancer (IBC). Design: Retrospective cohort, 1985-2003. Setting: Tertiary referral center. Patients: Consecutive patients with a primary occurrence of IBC. Main Outcome Measures: All-cause and disease-free survival. Results: One-hundred fifty-six patients were identified with IBC; 28 patients with metastatic disease were excluded from further analysis. The mean age of the remaining 128 patients was 53 years; 57% of women were postmenopausal. One hundred twenty-two patients had clinically apparent IBC. Tumors were palpable in 83 patients (mean diameter, 9.1 cm). Neoadjuvant chemotherapy was the initial therapy in 106 patients, while surgery was the initial therapy in 22 patients. The overall median survival was 37 months, with a median disease-free interval of 23 months. The 5-year survival was 42%, with a disease-free survival of 21%. Univariate analysis of recurrence identified previous hormone therapy (relative risk [RR], 0.50; P=.03), menopause (RR, 0.55; P=.01), and palpable adenopathy (RR, 1.57; P=.04) as significant factors. Univariate survival analysis highlighted previous hormone therapy (RR, 0.48; P=.04), radiotherapy (RR, 0.39; P=.02), sequence of therapy (P=.001), family history (RR, 0.47; P=.01), and palpable adenopathy (RR, 2.22; P<.001) as being important. Multivariate analysis of recurrence identified menopausal status as the key factor. Adenopathy at the initial examination was associated with decreased length of survival, while radiotherapy was associated with better survival. Conclusions: Survival from IBC remains poor. Although adenopathy and radiotherapy affected survival by multivariate analysis, the sequence of therapy was not associated with improved outcome.
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