Department of Surgery/BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2019 Jan;233:436-443. doi: 10.1016/j.jss.2018.08.011. Epub 2018 Sep 21.
Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) for breast cancer is associated with improved survival and facilitates conservative surgical strategies. Invasive lobular carcinoma (ILC) has been observed to have decreased response to NCT compared with invasive ductal carcinoma (IDC). This study seeks to evaluate national trends in the use of NCT for ILC compared with IDC, and determine if there is a subset of ILC patients who demonstrate favorable response rates.
This is a study using the National Cancer Database. The cohort consisted of patients with stage 1-3 ILC treated between 2010 and 2014, and a reference cohort of patient with IDC. For patients receiving NCT, pCR was assessed and clinically relevant variables were used in multivariable logistic regression models for each histologic subtype, modeling for pCR achievement. Survival analysis was performed for each histologic group to evaluate potential survival benefits of achieving pCR.
Our study cohort consisted of 384,887 women, of which 9.7% had ILC. A significantly lower rate of pCR after NCT was found in the cases of ILC compared with those of IDC (8.7% versus 23.2%). Increased response was seen in ILC patients with HER2-positive and TNBC subtypes. A survival benefit was demonstrated in patients with ILC who achieved pCR.
While response to NCT in patients with ILC is uncommon, our findings demonstrate a selective benefit for patients with HER2-positive tumors and TNBC. In addition, pCR is correlated with a clear survival advantage in ILC.
乳腺癌新辅助化疗（NCT）后的病理完全缓解（pCR）与生存改善相关，并促进了保守的手术策略。与浸润性导管癌（IDC）相比，浸润性小叶癌（ILC）对 NCT 的反应降低。本研究旨在评估 NCT 治疗 ILC 与 IDC 的全国趋势，并确定是否存在对 NCT 反应良好的 ILC 患者亚组。
这是一项使用国家癌症数据库的研究。队列包括 2010 年至 2014 年间接受 1-3 期 ILC 治疗的患者，以及 IDC 患者的参考队列。对于接受 NCT 的患者，评估 pCR，并在每个组织学亚型的多变量逻辑回归模型中使用临床相关变量，以建模 pCR 实现。对每个组织学组进行生存分析，以评估实现 pCR 的潜在生存获益。
我们的研究队列包括 384887 名女性，其中 9.7%患有 ILC。与 IDC 相比，NCT 后 ILC 的 pCR 率明显较低（8.7%对 23.2%）。在 HER2 阳性和三阴性乳腺癌（TNBC）亚型的 ILC 患者中，观察到反应增加。在实现 pCR 的 ILC 患者中，生存获益得到证实。
虽然 ILC 患者对 NCT 的反应不常见，但我们的研究结果表明，HER2 阳性肿瘤和 TNBC 患者具有选择性获益。此外，pCR 与 ILC 明确的生存优势相关。
