Wang Song, Zhang Yiyuan, Yin Fangxu, Wang Xiaohong, Yang Zhenlin
Department of Thyroid and Breast Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, China.
Department of Reproductive Endocrinology, Affiliated Reproductive Hospital of Shandong University, Jinan, China.
Front Oncol. 2021 Nov 1;11:741737. doi: 10.3389/fonc.2021.741737. eCollection 2021.
Invasive micropapillary breast carcinoma (IMPC) is a relatively rare pathological type of invasive breast cancer. Little is currently known on the efficacy and safety of breast-conserving treatment (BCT, lumpectomy plus postsurgical radiation) compared with mastectomy in women diagnosed with early-stage IMPC. Accordingly, we sought to investigate the long-term prognostic differences between BCT and mastectomy in patients with T1-3N0-3M0 invasive micropapillary breast carcinoma using data from the Surveillance, Epidemiology, and End Results (SEER) database.
We retrospectively analyzed 1,203 female patients diagnosed with early-stage IMPC between 2004 and 2015 from the SEER database. The impact of different surgical approaches on patient prognosis was assessed by the Kaplan-Meier method and Cox proportional risk models.
A total of 609 and 594 patients underwent mastectomy and BCT, respectively. Compared with patients who underwent a mastectomy, patients in the BCT group were older and had lower tumor diameters, lower rates of lymph nodes metastasis, and higher rates of ER receptor positivity and PR receptor positivity ( < 0.05). Kaplan-Meier plots showed that the overall survival (OS) and breast cancer-specific survival (BCSS) were higher in the BCT group than in the mastectomy group. In subgroup analysis, patients with T2 stage in the BCT group had better OS than the mastectomy group. Multivariate analysis showed no statistical difference in OS and BCSS for patients in the mastectomy group compared with the BCT group (hazard ratio (HR) = 0.727; 95% confidence interval (95% CI) 0.369-1.432, = 0.357; HR = 0.762; 95% CI 0.302-1.923, = 0.565; respectively). During the multivariate analysis and stratifying for the T stage, a better OS was found for patients with T2 stage in the BCT group than the mastectomy group (HR = 0.333, 95% CI: 0.149-0.741, = 0.007). There was no significant difference in OS for patients with T1 and T3 stages between the BCT and mastectomy groups ( > 0.05).
In women with early-stage IMPC, BCT was at least equivalent to mastectomy in terms of survival outcomes. When both procedures are feasible, BCT should be recommended as the standard surgical treatment, especially for patients with T2 disease.
浸润性微乳头状乳腺癌（IMPC）是浸润性乳腺癌中一种相对罕见的病理类型。目前，对于早期IMPC女性患者，保乳治疗（BCT，乳房肿块切除术加术后放疗）与乳房切除术相比的疗效和安全性知之甚少。因此，我们试图利用监测、流行病学和最终结果（SEER）数据库的数据，研究T1-3N0-3M0浸润性微乳头状乳腺癌患者中BCT和乳房切除术的长期预后差异。
我们回顾性分析了2004年至2015年间SEER数据库中1203例诊断为早期IMPC的女性患者。采用Kaplan-Meier法和Cox比例风险模型评估不同手术方式对患者预后的影响。
分别有609例和594例患者接受了乳房切除术和BCT。与接受乳房切除术的患者相比，BCT组患者年龄更大，肿瘤直径更小，淋巴结转移率更低，雌激素受体（ER）阳性率和孕激素受体（PR）阳性率更高（P<0.05）。Kaplan-Meier曲线显示，BCT组的总生存期（OS）和乳腺癌特异性生存期（BCSS）高于乳房切除术组。亚组分析显示，BCT组T2期患者的OS优于乳房切除术组。多因素分析显示，乳房切除术组与BCT组患者的OS和BCSS无统计学差异（风险比（HR）=0.727；95%置信区间（95%CI）0.369-1.432，P=0.357；HR=0.762；95%CI 0.302-1.923，P=0.565）。在多因素分析中按T分期进行分层时，发现BCT组T2期患者的OS优于乳房切除术组（HR=0.333，95%CI：0.149-0.741，P=0.007）。BCT组和乳房切除术组T1期和T3期患者的OS无显著差异（P>0.05）。
对于早期IMPC女性患者，就生存结局而言，BCT至少与乳房切除术相当。当两种手术方式均可行时，应推荐BCT作为标准手术治疗，尤其是对于T2期疾病患者。
