目的:转移性乳腺癌的原发部位手术可改善局部控制,但不影响总生存期。组织学亚型是否会影响手术患者的选择尚不清楚。鉴于早期小叶疾病与导管疾病之间的手术治疗差异,我们评估了组织学对转移性乳腺癌患者原发部位手术的影响.
方法:国家癌症数据库(NCDB,2010-2016)询问IV期HR阳性患者,HER2阴性浸润性小叶癌(ILC)和浸润性导管癌(IDC)。我们比较了临床病理特征,主要部位手术率,和组织学亚型的结果。使用具有和不具有倾向评分匹配的多变量Cox比例风险模型进行总生存期(OS)分析。
结果:在25,294名患者中,与19,171例IDC患者相比,6,123例ILC患者的主要部位手术稍有但明显较少(26.9%对28.8%,p=0.004)。ILC患者接受化疗的可能性较小(41.3%对47.4%,p<0.0001)或放疗(29.1%对37.9%,p<0.0001),并且有较短的OS。虽然乳房切除术率相似,行肿块切除术的ILC患者的切缘阳性率明显较高(ILC15.7%vsIDC11.2%,p=0.025)。在这两组中,接受手术的几率随着时间的推移而下降,并且在患有T2/T3肿瘤和较高淋巴结负担的年轻患者中更高。
结论:小叶组织学与较少的原发部位手术有关,较高的正利润率,减少放疗和化疗,与HR阳性HER2阴性IDC相比,OS较短。这些发现支持在转移性疾病的背景下需要ILC特异性数据和治疗方法。
OBJECTIVE: Primary site surgery for metastatic breast cancer improves local control but does not impact overall survival. Whether histologic subtype influences patient selection for surgery is unknown. Given differences in surgical management between early-stage
lobular versus ductal disease, we evaluated the impact of histology on primary site surgery in patients with metastatic breast cancer.
METHODS: The National Cancer Database (NCDB, 2010-2016) was queried for patients with stage IV HR-positive, HER2-negative invasive
lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). We compared clinicopathologic features, primary site surgery rates, and outcomes by histologic subtype. Multivariable Cox proportional hazard models with and without propensity score matching were used for overall survival (OS) analyses.
RESULTS: In 25,294 patients, primary site surgery was slightly but significantly less common in the 6,123 patients with ILC compared to the 19,171 patients with IDC (26.9% versus 28.8%, p = 0.004). Those with ILC were less likely to receive chemotherapy (41.3% versus 47.4%, p < 0.0001) or radiotherapy (29.1% versus 37.9%, p < 0.0001), and had shorter OS. While mastectomy rates were similar, those with ILC who underwent lumpectomy had significantly higher positive margin rates (ILC 15.7% versus IDC 11.2%, p = 0.025). In both groups, the odds of undergoing surgery decreased over time, and were higher in younger patients with T2/T3 tumors and higher nodal burden.
CONCLUSIONS: Lobular histology is associated with less primary site surgery, higher positive margin rates, less radiotherapy and chemotherapy, and shorter OS compared to those with HR-positive HER2-negative IDC. These findings support the need for ILC-specific data and treatment approaches in the setting of metastatic disease.