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The impact of chemotherapy sequence on survival in node‐positive invasive lobular carcinoma
Author(s) -
Tamirisa Nina,
Williamson Hannah V.,
Thomas Samantha M.,
Westbrook Kelly E.,
Greenup Rachel A.,
Plichta Jennifer K.,
Rosenberger Laura H.,
Hyslop Terry,
Hwang EunSil Shelley,
Fayanju Oluwadamilola M.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25492
Subject(s) - medicine , hazard ratio , chemotherapy , proportional hazards model , mastectomy , invasive lobular carcinoma , confidence interval , breast cancer , oncology , surgery , carcinoma , survival analysis , cancer , gastroenterology , invasive ductal carcinoma
Background and Objectives We sought to evaluate the impact of chemotherapy sequence on survival by comparing node‐positive invasive lobular carcinoma (ILC) patients who received neoadjuvant (NACT) and adjuvant (ACT) chemotherapy. Methods cT1‐4c, cN1‐3 ILC patients in the National Cancer Data Base (2004‐2013) who underwent surgery and chemotherapy were divided into NACT and ACT cohorts. Kaplan‐Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. Results Five thousand five hundred fifty‐one (35.6%) of 15 573 ILC patients treated with chemotherapy received NACT. NACT patients had similar rates of pT3/4 disease (26.6% vs 26.2%), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14) but higher rates of mastectomy (81.8% vs 74.5%, P < 0.001) vs ACT patients. 3.4% of NACT patients experienced pathologic complete response (pCR). Unadjusted 10‐year OS was worse for NACT vs ACT patients (65.1% vs 54.4%, log‐rank P < 0.001). After adjustment for known covariates, NACT continued to be associated with worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.25‐1.52). Conclusions In node‐positive ILC, NACT yielded low rates of pCR, was not associated with lower rates of mastectomy or less extensive axillary surgery, and was associated with worse survival vs ACT, suggesting limited benefit for these patients.