PDF(Pubmed)
Abstract：
BACKGROUND: Quality of surgical care is understudied for lobular inflammatory breast cancer (IBC), which is less common, more chemotherapy-resistant, and more mammographically occult than ductal IBC. We compared guideline-concordant surgery (modified radical mastectomy [MRM] without immediate reconstruction following chemotherapy) for lobular versus ductal IBC.
METHODS: Female individuals with cT4dM0 lobular and ductal IBC were identified in the National Cancer Database (NCDB) from 2010-2019. Modified radical mastectomy receipt was identified via codes for \"modified radical mastectomy\" or \"mastectomy\" and \"≥10 lymph nodes removed\" (proxy for axillary lymph node dissection). Descriptive statistics, chi-square tests, and t-tests were used.
RESULTS: A total of 1456 lobular and 10,445 ductal IBC patients were identified; 599 (41.1%) with lobular and 4859 (46.5%) with ductal IBC underwent MRMs (p = 0.001). Patients with lobular IBC included a higher proportion of individuals with cN0 disease (20.5% lobular vs. 13.7% ductal) and no lymph nodes examined at surgery (31.2% vs. 24.5%) but were less likely to be node-negative at surgery (12.7% vs. 17.1%, all p < 0.001). Among those who had lymph nodes removed at surgery, patients with lobular IBC also had fewer lymph nodes excised versus patients with ductal IBC (median [interquartile range], 7 (0-15) vs. 9 (0-17), p = 0.001).
CONCLUSIONS: Lobular IBC patients were more likely to present with node-negative disease and less likely to be node-negative at surgery, despite having fewer, and more frequently no, lymph nodes examined versus ductal IBC patients. Future studies should investigate whether these treatment disparities are because of surgical approach, pathologic assessment, and/or data quality as captured in the NCDB.
METHODS: Female individuals with cT4dM0 lobular and ductal IBC were identified in the National Cancer Database (NCDB) from 2010-2019. Modified radical mastectomy receipt was identified via codes for \"modified radical mastectomy\" or \"mastectomy\" and \"≥10 lymph nodes removed\" (proxy for axillary lymph node dissection). Descriptive statistics, chi-square tests, and t-tests were used.
RESULTS: A total of 1456 lobular and 10,445 ductal IBC patients were identified; 599 (41.1%) with lobular and 4859 (46.5%) with ductal IBC underwent MRMs (p = 0.001). Patients with lobular IBC included a higher proportion of individuals with cN0 disease (20.5% lobular vs. 13.7% ductal) and no lymph nodes examined at surgery (31.2% vs. 24.5%) but were less likely to be node-negative at surgery (12.7% vs. 17.1%, all p < 0.001). Among those who had lymph nodes removed at surgery, patients with lobular IBC also had fewer lymph nodes excised versus patients with ductal IBC (median [interquartile range], 7 (0-15) vs. 9 (0-17), p = 0.001).
CONCLUSIONS: Lobular IBC patients were more likely to present with node-negative disease and less likely to be node-negative at surgery, despite having fewer, and more frequently no, lymph nodes examined versus ductal IBC patients. Future studies should investigate whether these treatment disparities are because of surgical approach, pathologic assessment, and/or data quality as captured in the NCDB.
摘要：
背景：对小叶炎性乳腺癌（IBC）的外科护理质量研究不足，这是不太常见的，对化疗的抵抗力更强，比导管IBC更隐匿性。我们比较了小叶和导管IBC的指南一致手术（改良根治术[MRM]，化疗后不立即重建）。
方法：2010-2019年在国家癌症数据库（NCDB）中确定了患有cT4dM0小叶和导管IBC的女性个体。通过“改良根治术”或“乳房切除术”和“≥10个淋巴结切除”（代表腋窝淋巴结清扫）的代码确定了改良根治术收据。描述性统计，卡方检验,并使用t检验。
结果：共确定了1456例小叶和10,445例导管IBC患者；599例（41.1％）的小叶和4859例（46.5％）的导管IBC患者接受了MRM（p=0.001）。小叶性IBC患者包括较高比例的cN0疾病患者（小叶性与13.7％的导管）和手术时无淋巴结检查（31.2％与24.5%），但手术时淋巴结阴性的可能性较小（12.7%与17.1%,所有p<0.001)。在手术切除淋巴结的人中，与导管IBC患者相比，小叶IBC患者切除的淋巴结也较少（中位数[四分位距]，7（0-15）vs.9（0-17）p=0.001)。
结论：小叶性IBC患者在手术时更容易出现淋巴结阴性疾病，而不太可能出现淋巴结阴性。尽管数量较少,更常见的是没有，淋巴结检查与导管IBC患者。未来的研究应该调查这些治疗差异是否是因为手术方法，病理评估，和/或NCDB中捕获的数据质量。
方法：2010-2019年在国家癌症数据库（NCDB）中确定了患有cT4dM0小叶和导管IBC的女性个体。通过“改良根治术”或“乳房切除术”和“≥10个淋巴结切除”（代表腋窝淋巴结清扫）的代码确定了改良根治术收据。描述性统计，卡方检验,并使用t检验。
结果：共确定了1456例小叶和10,445例导管IBC患者；599例（41.1％）的小叶和4859例（46.5％）的导管IBC患者接受了MRM（p=0.001）。小叶性IBC患者包括较高比例的cN0疾病患者（小叶性与13.7％的导管）和手术时无淋巴结检查（31.2％与24.5%），但手术时淋巴结阴性的可能性较小（12.7%与17.1%,所有p<0.001)。在手术切除淋巴结的人中，与导管IBC患者相比，小叶IBC患者切除的淋巴结也较少（中位数[四分位距]，7（0-15）vs.9（0-17）p=0.001)。
结论：小叶性IBC患者在手术时更容易出现淋巴结阴性疾病，而不太可能出现淋巴结阴性。尽管数量较少,更常见的是没有，淋巴结检查与导管IBC患者。未来的研究应该调查这些治疗差异是否是因为手术方法，病理评估，和/或NCDB中捕获的数据质量。
