Öztekin Selin, Hooning Maartje J, van Deurzen Carolien H M, Dietvorst Anne-Marie H P, Drooger Jan C, Kitzen Jos J E M, Martens John W M, van der Padt-Pruijsten Annemieke, Vastbinder Mijntje B, Zuetenhorst Hanneke, Heemskerk-Gerritsen Bernadette A M, Jager Agnes
Department of Medical Oncology, Erasmus Medical Center (MC) Cancer Institute, Rotterdam, the Netherlands.
Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Cancer. 2024 Mar 15;130(6):927-935. doi: 10.1002/cncr.35125. Epub 2023 Nov 20.
Despite histological and molecular differences between invasive lobular carcinoma (ILC) and invasive carcinoma of no special type, according to national treatment guidelines no distinction is made regarding the use of (neo)adjuvant chemotherapy. Studies on the long-term outcome of chemotherapy in patients with ILC are scarce and show inconclusive results.
All patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative ILC with an indication for chemotherapy treated with adjuvant endocrine therapy were selected from the Erasmus Medical Center Breast Cancer database. Cox proportional hazards models were used to estimate the effect of chemotherapy on recurrence-free survival (RFS), breast cancer-specific survival (BCSS), and overall survival (OS).
A total of 520 patients were selected, of whom 379 were treated with chemotherapy and 141 were not. Patients in the chemotherapy group were younger (51 vs. 61 years old; p < .001), had a higher T status (T3+, 33% vs. 14%; p < .001), and more often had lymph node involvement (80% vs. 49%; p < .001) in comparison to the no-chemotherapy group. After adjusting for confounders, chemotherapy treatment was not associated with better RFS (hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.63-2.31), BCSS (HR, 1.24; 95% CI, 0.60-2.58), or OS (HR, 0.97; 95% CI, 0.56-1.66). This was also reflected by adjusted Cox survival curves in the chemotherapy versus no-chemotherapy group for RFS (75% vs. 79%), BCSS (80% vs. 84%), and OS (72% vs. 71%).
Chemotherapy is not associated with improved RFS, BCSS, or OS for patients with ER+/HER2- ILC treated with adjuvant endocrine therapy and with an indication for chemotherapy.
尽管浸润性小叶癌（ILC）与非特殊类型浸润性癌在组织学和分子水平上存在差异，但根据国家治疗指南，在（新）辅助化疗的使用方面并未进行区分。关于ILC患者化疗长期疗效的研究较少，且结果尚无定论。
从伊拉斯谟医学中心乳腺癌数据库中选取所有接受辅助内分泌治疗且有化疗指征的雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性的ILC患者。采用Cox比例风险模型评估化疗对无复发生存期（RFS）、乳腺癌特异性生存期（BCSS）和总生存期（OS）的影响。
共选取520例患者，其中379例接受化疗，141例未接受化疗。与未化疗组相比，化疗组患者更年轻（51岁对61岁；p <.001），T分期更高（T3 +，33%对14%；p <.001），且淋巴结受累情况更常见（80%对49%；p <.001）。在对混杂因素进行校正后，化疗与更好的RFS（风险比[HR]，1.20；95%置信区间[CI]，0.63 - 2.31）、BCSS（HR，1.24；95% CI，0.60 - 2.58）或OS（HR，0.97；95% CI，0.56 - 1.66）无关。这也反映在化疗组与未化疗组的RFS（75%对79%）、BCSS（80%对84%）和OS（72%对71%）的校正Cox生存曲线上。
对于接受辅助内分泌治疗且有化疗指征的ER + /HER2 - ILC患者，化疗与改善RFS、BCSS或OS无关。
