Differences in Response and Surgical Management with Neoadjuvant Chemotherapy in Invasive Lobular Versus Ductal Breast Cancer.
Differences in Response and Surgical Management with Neoadjuvant Chemotherapy in Invasive Lobular Versus Ductal Breast Cancer.
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DOI：
10.1245/s10434-015-4603-3
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发表时间：
2016-01
影响因子：
3.7
通讯作者：
Voogd AC
中科院分区：
文献类型：
--
作者：
Truin W;Vugts G;Roumen RM;Maaskant-Braat AJ;Nieuwenhuijzen GA;van der Heiden-van der Loo M;Tjan-Heijnen VC;Voogd AC
本研究旨在确定新辅助化疗（NAC）对浸润性小叶乳腺癌（ILC）和浸润性导管癌（IDC）患者行保乳手术（BCS）可能性的影响。2008年7月至2012年12月期间在荷兰诊断为ILC或IDC的女性患者通过基于人群的荷兰癌症登记处确定。共有466名ILC患者接受了NAC治疗，而IDC患者为3622名。49.7%的ILC患者和69.6%的IDC患者中观察到NAC分期下调，分别在4.9%和20.2%的这些患者中观察到病理完全缓解（pCR）（P < 0.0001）。24.4%接受NAC的ILC患者和39.4%接受IDC的患者进行了保乳手术。在ILC组中，8.2%的患者在BCS后由于肿瘤切除边缘阳性而需要再次手术，而IDC组为3.4%（P < 0.0001）。小叶组织学与较高的乳房切除率独立相关（优势比1.91; 95%置信区间1.49-2.44）。在临床T2和T3期疾病患者中，ILC和IDC使用NAC时更常达到BCS。与IDC患者相比，接受NAC的ILC患者不太可能经历pCR，也不太可能经历BCS。就BCS而言，NAC对ILC患者的影响低于接受手术但未接受NAC的患者。然而，尽管为了实现BCS而进行治疗的人数很多，但一小部分ILC患者，特别是cT 2和cT 3患者，仍然可以从NAC中获益。
This study was conducted to determine the impact of neoadjuvant chemotherapy (NAC) on the likelihood of breast-conserving surgery (BCS) performed for patients with invasive lobular breast carcinoma (ILC) and invasive ductal carcinoma (IDC). Female patients with a diagnosis of ILC or IDC in The Netherlands between July 2008 and December 2012 were identified through the population-based Netherlands Cancer Registry. A total of 466 ILC patients received NAC compared with 3622 IDC patients. Downstaging by NAC was seen in 49.7 % of the patients with ILC and in 69.6 % of the patients with IDC, and a pathologic complete response (pCR) was observed in 4.9 and 20.2 % of these patients, respectively (P < 0.0001). Breast-conserving surgery was performed for 24.4 % of the patients with ILC receiving NAC versus 39.4 % of the patients with IDC. In the ILC group, 8.2 % of the patients needed surgical reinterventions after BCS due to tumor-positive resection margins compared with 3.4 % of the patients with IDC (P < 0.0001). Lobular histology was independently associated with a higher mastectomy rate (odds ratio 1.91; 95 % confidence interval 1.49–2.44). Among the patients with clinical T2 and T3 disease, BCS was achieved more often when NAC was administered in ILC as well as IDC. The patients with ILC receiving NAC were less likely to experience a pCR and less likely to undergo BCS than the patients with IDC. With regard to BCS, the impact of NAC for ILC patients was lower than for patients receiving surgery without NAC. However, despite the high number to treating in order to achieve BCS, a small subset of ILC patients, especially cT2 and cT3 patients, still may benefit from NAC.