Mateo Alina M, Pezzi Todd A, Sundermeyer Mark, Kelley Cynthia A, Klimberg V Suzanne, Pezzi Christopher M
Department of Surgery, Abington Hospital-Jefferson Health, Abington, PA, USA.
Baylor College of Medicine, Houston, TX, USA.
Ann Surg Oncol. 2017 Apr;24(4):1050-1056. doi: 10.1245/s10434-016-5649-6. Epub 2016 Nov 2.
Medullary breast cancer (MBC) is a rare tumor associated with a better prognosis compared with other breast cancers. The role of adjuvant chemotherapy has not been extensively studied.
Female patients with invasive MBC reported to the National Cancer Data Base from 2004 to 2012 were analyzed. Overall survival (OS) and treatment were studied using the Kaplan-Meier method and the Cox proportional hazard model. Patients who had node-negative (N0), non-metastatic (M0) tumors 10 to 50 mm in size (T1cN0M0 and T2N0M0) treated with and without chemotherapy were analyzed using propensity score matching.
Of 3739 patients with MBC, 2642 (71%) had T1b-T2N0M0 disease treated with and without chemotherapy. Multivariable analysis showed that for all MBC patients, the significant predictors of OS were age older than 65 years, one or more comorbidities, tumor larger than 2 cm, positive nodes, distant metastasis, and treatment with chemotherapy or radiation therapy. Patients with T1cN0M0 and T2N0M0 had improved OS if they received chemotherapy (p < 0.0005). Patients with T1bN0M0 who received chemotherapy did not show better OS than those who did not. Patients with T1c-T2N0M0 were then matched by propensity score based on age, presence of comorbidities, tumor size, and treatment methods used. After matching, the group receiving chemotherapy showed an improved OS (hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.26-0.62; p < 0.0005) compared to the group that did not receive chemotherapy.
For patients with T1c-T2N0M0 MBC, chemotherapy significantly improves OS.
髓样乳腺癌（MBC）是一种罕见肿瘤，与其他乳腺癌相比预后较好。辅助化疗的作用尚未得到广泛研究。
对2004年至2012年向国家癌症数据库报告的浸润性MBC女性患者进行分析。采用Kaplan-Meier法和Cox比例风险模型研究总生存期（OS）和治疗情况。对肿瘤大小为10至50毫米（T1cN0M0和T2N0M0）的淋巴结阴性（N0）、无转移（M0）的患者，分析其接受化疗和未接受化疗的情况，并进行倾向评分匹配。
在3739例MBC患者中，2642例（71%）患有T1b-T2N0M0疾病，接受了化疗和未接受化疗。多变量分析显示，对于所有MBC患者，OS的显著预测因素为年龄大于65岁、一种或多种合并症、肿瘤大于2厘米、阳性淋巴结、远处转移以及接受化疗或放疗。T1cN0M0和T2N0M0患者接受化疗后OS有所改善（p < 0.0005）。接受化疗的T1bN0M0患者的OS并不比未接受化疗的患者更好。然后根据年龄、合并症的存在、肿瘤大小和所用治疗方法，对T1c-T2N0M0患者进行倾向评分匹配。匹配后，接受化疗的组与未接受化疗的组相比，OS有所改善（风险比[HR]，0.40；95%置信区间[CI]，0.26-0.62；p < 0.0005）。
对于T1c-T2N0M0 MBC患者，化疗可显著改善OS。
