The incidence of discordant clinical and genomic risk in patients with invasive lobular or ductal carcinoma of the breast: a National Cancer Database Study.
The incidence of discordant clinical and genomic risk in patients with invasive lobular or ductal carcinoma of the breast: a National Cancer Database Study.
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DOI：
10.1038/s41523-021-00366-x
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发表时间：
2021-12-21
影响因子：
5.9
通讯作者：
Mukhtar RA
中科院分区：
文献类型：
--
作者：
Abel MK;Shui AM;Melisko M;Chien AJ;Yoshida EJ;Lancaster EM;Van 't Veer L;Esserman LJ;Mukhtar RA
当分子检测将乳腺肿瘤归类为低风险但临床风险较高时，最佳管理策略是未知的。一组更有可能出现这种不一致风险的患者是患有浸润性小叶癌的患者。我们试图检查与浸润性导管癌患者相比，浸润性小叶癌患者是否更有可能患有临床高风险/基因组低风险肿瘤，并评估其对接受化疗和总生存期的影响。我们利用 2010 年至 2016 年国家癌症数据库进行了一项队列研究。激素受体阳性、HER2 阴性、I-III 期乳腺癌患者接受了 70 个基因特征检测。我们使用 Kaplan-Meier 图、对数秩检验和带有或不带有倾向评分匹配的 Cox 比例风险模型，通过组织学评估了临床和基因组风险不一致的患者比例。总共确定了 7399 名患者（1497 名患有浸润性小叶癌 [20.2%]）。与浸润性导管癌患者相比，浸润性小叶癌患者更容易陷入不一致的风险类别（46.8% vs 37.1%，p<0.001），特别是在临床高/基因组低风险亚组中（35.6% vs 19.2%，p<0.001）。在对接受化疗的临床高风险/基因组低风险队列的未经调整的分析中，与浸润性小叶癌患者相比，浸润性导管癌患者的总生存期显着改善（p = 0.02）。这些发现表明，对于浸润性小叶癌患者，可以改进当前用于分层临床和基因组风险的工具，以更好地调整治疗选择。
When molecular testing classifies breast tumors as low risk but clinical risk is high, the optimal management strategy is unknown. One group of patients who may be more likely to have such discordant risk are those with invasive lobular carcinoma of the breast. We sought to examine whether patients with invasive lobular carcinoma are more likely to have clinical high/genomic low-risk tumors compared to those with invasive ductal carcinoma, and to evaluate the impact on receipt of chemotherapy and overall survival. We conducted a cohort study using the National Cancer Database from 2010–2016. Patients with hormone receptor positive, HER2 negative, stage I-III breast cancer who underwent 70-gene signature testing were included. We evaluated the proportion of patients with discordant clinical and genomic risk by histology using Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models with and without propensity score matching. A total of 7399 patients (1497 with invasive lobular carcinoma [20.2%]) were identified. Patients with invasive lobular carcinoma were significantly more likely to fall into a discordant risk category compared to those with invasive ductal carcinoma (46.8% versus 37.1%, p < 0.001), especially in the clinical high/genomic low risk subgroup (35.6% versus 19.2%, p < 0.001). In unadjusted analysis of the clinical high/genomic low-risk cohort who received chemotherapy, invasive ductal carcinoma patients had significantly improved overall survival compared to those with invasive lobular carcinoma (p = 0.02). These findings suggest that current tools for stratifying clinical and genomic risk could be improved for those with invasive lobular carcinoma to better tailor treatment selection.
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DOI：
10.1056/nejmoa2108873
发表时间：
2021-12-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
--
影响因子：
3.7
作者：
Chen, Zheling;Yang, Jiao;Yang, Jin
通讯作者：
Yang, Jin
影响因子：
3.8
作者：
Soliman, Hatem;Shah, Varsha;Audeh, William
通讯作者：
Audeh, William
影响因子：
45.3
作者：
Bilimoria, Karl Y.;Bentrem, David J.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.
影响因子：
158.5
作者：
Cardoso, F.;van't Veer, L. J.;Piccart, M.
通讯作者：
Piccart, M.