Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland; Department of Surgery, Royal College of Surgeons Ireland, Dublin 2, Ireland.
Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.
Breast. 2022 Feb;61:1-10. doi: 10.1016/j.breast.2021.11.017. Epub 2021 Dec 1.
Meta-analysis of >87,000 patients demonstrates that patients with invasive lobular carcinoma of the breast are far less likely to achieve pCR of the breast or axilla compared to their ductal counterparts, receive less BCS and more frequently return positive margins.
Neoadjuvant chemotherapy (NACT) facilitates tumour downstaging, increases breast conserving surgery (BCS) and assesses tumour chemosensitivity. Despite clinicopathological differences in Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC), decision making surrounding the use NACT does not take account of histological differences.
To determine the impact NACT on pathological complete response (pCR), breast conserving surgery (BCS), margin status and axillary pCR in ILC and IDC.
A systematic review was performed in accordance with the PRISMA guidelines. Studies reporting outcomes among ILC and IDCs following NACT were identified. Dichotomous variables were pooled as odds ratios (ORs) with 95% confidence intervals_(CI) using the Mantel-Haenszel method. P-values <0.05 were statistically significant.
40 studies including 87,303 (7596 ILC [8.7%]and 79,708 IDC [91.3%]) patients were available for analysis. Mean age at diagnosis was 54.9 vs. 50.9 years for ILC and IDC, respectively. IDCs were significantly more likely to achieve pCR (22.1% v 7.4%, OR: 3.03 [95% CI 2.5-3.68] p < 0.00001), axillary pCR (23.6% vs. 13.4%, OR: 2.01 [95% CI 1.77-2.28] p < 0.00001) and receive BCS (45.7% vs. 33.3%, OR 2.14 [95% CI 1.87-2.45] p < 0.00001) versus ILCs. ILCs were significantly more likely to have positive margins at the time of surgery (36% vs 13.5%, OR 4.84 [95% CI 2.88-8.15] p < 0.00001).
This is the largest study comparing the impact of NACT among ILC and IDC with respect to pCR and BCS. ILC has different outcomes to IDC following NACT and incorporate it into treatment decisions and future clinical guidelines.
确定新辅助化疗（NACT）对浸润性小叶癌（ILC）和浸润性导管癌（IDC）患者病理完全缓解（pCR）、保乳手术（BCS）、切缘状态和腋窝 pCR 的影响。
按照 PRISMA 指南进行系统评价。确定报告 NACT 后 ILC 和 IDC 患者结局的研究。使用 Mantel-Haenszel 方法，将二分类变量汇总为优势比（OR）及其 95%置信区间（CI）。P 值<0.05 为统计学显著。
40 项研究纳入 87303 例（7596 例 ILC[8.7%]和 79708 例 IDC[91.3%]）患者，可进行分析。诊断时的平均年龄分别为 ILC 组 54.9 岁和 IDC 组 50.9 岁。IDC 患者更有可能达到 pCR（22.1%对 7.4%，OR：3.03[95%CI 2.5-3.68]p<0.00001）、腋窝 pCR（23.6%对 13.4%，OR：2.01[95%CI 1.77-2.28]p<0.00001）和接受 BCS（45.7%对 33.3%，OR：2.14[95%CI 1.87-2.45]p<0.00001）的可能性高于 ILC 患者。ILC 患者在手术时更有可能出现阳性切缘（36%对 13.5%，OR：4.84[95%CI 2.88-8.15]p<0.00001）。
这是一项比较 ILC 和 IDC 患者新辅助化疗后 pCR 和 BCS 影响的最大规模研究。ILC 在接受 NACT 治疗后与 IDC 具有不同的结局，应将其纳入治疗决策和未来的临床指南中。
