The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma
The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma
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DOI：
10.1002/jso.25492
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发表时间：
2019-08-01
影响因子：
2.5
通讯作者：
Fayanju, Oluwadamilola M.
中科院分区：
文献类型：
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作者：
Tamirisa, Nina;Williamson, Hannah V.;Fayanju, Oluwadamilola M.
背景和目的我们通过比较接受新辅助（NACT）和辅助（ACT）化疗的淋巴结阳性浸润性小叶癌（ILC）患者，试图评估化疗顺序对生存率的影响。方法将2004-2013年国家癌症数据库中接受手术和化疗的cT 1 -4c、cN 1 -3 ILC患者分为NACT和ACT队列。Kaplan-Meier曲线和考克斯比例风险模型分别用于估计未校正和校正的总生存期（OS）。结果15573例ILC患者中有5551例（35.6%）接受了NACT治疗。与ACT患者相比，NACT患者的pT 3/4疾病（26.6% vs 26.2%）、淋巴结受累（中位数3 vs 4）和检查的淋巴结数量（中位数13 vs 14）的发生率相似，但乳房切除率较高（81.8% vs 74.5%，P < 0.001）。3.4%的NACT患者出现病理完全缓解（pCR）。NACT患者的未校正10年OS比ACT患者差（65.1% vs 54.4%，对数秩P < 0.001）。校正已知协变量后，NACT仍与OS较差相关（风险比[HR]，1.38; 95%置信区间[CI]，1.25-1.52）。结论：在淋巴结阳性ILC中，NACT的pCR率较低，与乳腺切除率较低或腋窝手术范围较小无关，与ACT相比，NACT的生存率较低，表明这些患者获益有限。
Background and Objectives We sought to evaluate the impact of chemotherapy sequence on survival by comparing node-positive invasive lobular carcinoma (ILC) patients who received neoadjuvant (NACT) and adjuvant (ACT) chemotherapy. Methods cT1-4c, cN1-3 ILC patients in the National Cancer Data Base (2004-2013) who underwent surgery and chemotherapy were divided into NACT and ACT cohorts. Kaplan-Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. Results Five thousand five hundred fifty-one (35.6%) of 15 573 ILC patients treated with chemotherapy received NACT. NACT patients had similar rates of pT3/4 disease (26.6% vs 26.2%), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14) but higher rates of mastectomy (81.8% vs 74.5%, P < 0.001) vs ACT patients. 3.4% of NACT patients experienced pathologic complete response (pCR). Unadjusted 10-year OS was worse for NACT vs ACT patients (65.1% vs 54.4%, log-rank P < 0.001). After adjustment for known covariates, NACT continued to be associated with worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.25-1.52). Conclusions In node-positive ILC, NACT yielded low rates of pCR, was not associated with lower rates of mastectomy or less extensive axillary surgery, and was associated with worse survival vs ACT, suggesting limited benefit for these patients.