髓样乳腺癌的预后：13 项国际乳腺癌研究组（IBCSG）试验分析。
Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials.
机构信息
Breast Center, Kantonsspital, St Gallen; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland.
IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston; Frontier Science and Technology Research Foundation, Boston, USA.
出版信息
Ann Oncol. 2012 Nov;23(11):2843-2851. doi: 10.1093/annonc/mds105. Epub 2012 Jun 14.
BACKGROUND
To evaluate whether medullary breast cancer has a better prognosis compared with invasive ductal tumors.
METHODS
Among 12,409 patients, 127 were recorded as invasive medullary tumors and 8096 invasive ductal tumors. Medullary and ductal invasive tumors were compared with regard to stage, age at diagnosis, grade, hormone receptor status, peritumoral vascular invasion, and local and systemic treatment. Pattern of relapse, distant recurrence-free interval (DRFI), and overall survival (OS) were determined for both histological groups. Two cohorts were investigated: a full cohort including the pathologist-determined medullary histology without regard to any other tumor features and a cohort restricted to patients with ER-negative grade 3 tumors.
RESULTS
Fourteen-year DRFI and OS percents for medullary tumors (n = 127) and invasive ductal tumors (n = 8096) of the full cohort were 76% and 64% [hazard ratio (HR) 0.52, P = 0.0005] and 66% and 57% (HR = 0.75, P = 0.03), respectively. For the restricted cohort, 14-year DRFI and OS percents for the medullary (n = 47) and invasive ductal tumors (n = 1407) were 89% and 63% (HR 0.24, P = 0.002) and 74% and 54% (HR = 0.55, P = 0.01), respectively. Competing risk analysis for DRFI favored medullary tumors (HR medullary/ductal = 0.32; 95% confidence interval = 0.13-0.78, P = 0.01).
CONCLUSION
Medullary tumors have a favorable prognosis compared with invasive ductal tumors.
背景
评估乳腺髓样癌与浸润性导管肿瘤相比是否具有更好的预后。
方法
在 12409 例患者中，有 127 例被记录为浸润性髓样肿瘤，8096 例为浸润性导管肿瘤。比较了髓样和导管浸润性肿瘤的分期、诊断时的年龄、分级、激素受体状态、肿瘤周围血管侵犯以及局部和全身治疗。确定了两个组织学组的复发模式、远处无复发生存期（DRFI）和总生存期（OS）。研究了两个队列：一个全队列，包括病理学家确定的髓样组织学，不考虑任何其他肿瘤特征；一个队列仅限于 ER 阴性 3 级肿瘤患者。
结果
全队列中，浸润性髓样肿瘤（n=127）和浸润性导管肿瘤（n=8096）的 14 年 DRFI 和 OS 百分比分别为 76%和 64%[风险比（HR）0.52，P=0.0005]和 66%和 57%（HR=0.75，P=0.03）。对于受限队列，浸润性髓样肿瘤（n=47）和浸润性导管肿瘤（n=1407）的 14 年 DRFI 和 OS 百分比分别为 89%和 63%（HR0.24，P=0.002）和 74%和 54%（HR=0.55，P=0.01）。DRFI 的竞争风险分析有利于髓样肿瘤（HR 髓样/导管=0.32；95%置信区间 0.13-0.78，P=0.01）。
结论
与浸润性导管肿瘤相比，乳腺髓样癌具有更好的预后。
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