한빛사논문
- 조회284
동남권원자력의학원
Tae In Yoon, MD1; Joon Jeong, MD, PhD2; Seokwon Lee, MD, PhD3; Jai Min Ryu, MD, PhD4; Young Joo Lee, MD5; Jee Yeon Lee, MD, PhD6; Ki-Tae Hwang, MD, PhD7; Hakyoung Kim, MD8; Seonok Kim, MSc9; Sae Byul Lee, MD, PhD10; Beom Seok Ko, MD, PhD10; Jong Won Lee, MD, PhD10; Byung Ho Son, MD, PhD10; Otto Metzger, MD11; Hee Jeong Kim, MD, PhD10
1Division of Breast Surgery, Department of Surgery, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
2Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
3Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
4Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5Division of Breast Surgery, Department of Surgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
6Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
7Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government–Seoul National University, Boramae Medical Center, Seoul, Korea
8Department of Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
9Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
10Division of Breast, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
11Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Corresponding Author: Hee Jeong Kim, MD, PhD
Abstract
Importance: The disparate prognostic implications between invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) have been demonstrated. However, information on premenopausal patients remains insufficient.
Objective: To examine long-term survival outcomes of ILC and IDC in premenopausal patients using national databases.
Design, setting, and participants: This cohort study used the Surveillance, Epidemiology, and End Results (SEER), Korean Breast Cancer Registry (KBCR), and Asan Medical Center Research (AMCR) databases to identify premenopausal patients with stage I to III ILC or IDC between January 1, 1990, and December 31, 2015. The median follow-up time was 90 (IQR, 40-151) months in the SEER database, 94 (IQR, 65-131) months in the KBCR database, and 120 (IQR, 86-164) months in the AMCR database. Data were analyzed from January 1 to May 31, 2023.
Main outcomes and measures: The primary outcome was breast cancer-specific survival (BCSS), which was analyzed according to histological type, and the annual hazard rate was evaluated. Survival rates were analyzed using a log-rank test and a Cox proportional hazards regression model with time-varying coefficients. Multivariable analysis was performed by adjusting for tumor characteristics and treatment factors.
Results: A total of 225 938 women diagnosed with IDC or ILC and younger than 50 years were identified. Mean (SD) age at diagnosis was 42.7 (5.3) years in the SEER database, 41.8 (5.5) years in the KBCR database, and 41.8 (5.5) years in the AMCR database. In terms of race (available for the SEER database only), 12.4% of patients were Black, 76.1% were White, 11.0% were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander), and 0.5% were of unknown race). Patients with ILC had better BCSS in the first 10 years after diagnosis than those with IDC (hazard ratios [HRs], 0.73 [95% CI, 0.68-0.78] in the SEER database, 1.20 [95% CI, 0.91-1.58] in the KBCR database, and 0.50 [95% CI, 0.29-0.86] in the AMCR database), although BCSS was worse after year 10 (HRs, 1.80 [95% CI, 1.59-2.02] in the SEER database, 2.79 [95% CI, 1.32-5.88] in the KBCR database, and 2.23 [95% CI, 1.04-4.79] in the AMCR database). Similar trends were observed for hormone receptor-positive tumors (HRs, 1.55 [95% CI, 1.37-1.75] in the SEER database, 2.27 [95% CI, 1.01-5.10] in the KBCR database, and 2.12 [95% CI, 0.98-4.60] in the AMCR database). Considering the annual hazard model of BCSS, IDC events tended to decline steadily after peaking 5 years before diagnosis. However, the annual peak event of BCSS was observed 5 years after diagnosis for ILC, which subsequently remained constant.
Conclusions and relevance: These findings suggest that premenopausal women with ILC have worse BCSS estimates than those with IDC, which can be attributed to a higher late recurrence rate of ILC than that of IDC. Histological subtypes should be considered when determining the type and duration of endocrine therapy in premenopausal women.
논문정보
- Research article
- 2023년 11월 (BRIC 등록일 2023-11-14)
- 국내(교신)+국외 연구진
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