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The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma.

Publication ,  Journal Article
Tamirisa, N; Williamson, HV; Thomas, SM; Westbrook, KE; Greenup, RA; Plichta, JK; Rosenberger, LH; Hyslop, T; Hwang, E-SS; Fayanju, OM
Published in: J Surg Oncol
August 2019

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.

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Published In

J Surg Oncol

DOI

EISSN

1096-9098

Publication Date

August 2019

Volume

120

Issue

2

Start / End Page

132 / 141

Location

United States

Related Subject Headings

  • Survival Rate
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Invasiveness
  • Neoadjuvant Therapy
  • Middle Aged
  • Mastectomy
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Tamirisa, N., Williamson, H. V., Thomas, S. M., Westbrook, K. E., Greenup, R. A., Plichta, J. K., … Fayanju, O. M. (2019). The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma. J Surg Oncol, 120(2), 132–141. https://doi.org/10.1002/jso.25492
Tamirisa, Nina, Hannah V. Williamson, Samantha M. Thomas, Kelly E. Westbrook, Rachel A. Greenup, Jennifer K. Plichta, Laura H. Rosenberger, Terry Hyslop, Eun-Sil Shelley Hwang, and Oluwadamilola M. Fayanju. “The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma.J Surg Oncol 120, no. 2 (August 2019): 132–41. https://doi.org/10.1002/jso.25492.
Tamirisa N, Williamson HV, Thomas SM, Westbrook KE, Greenup RA, Plichta JK, et al. The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma. J Surg Oncol. 2019 Aug;120(2):132–41.
Tamirisa, Nina, et al. “The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma.J Surg Oncol, vol. 120, no. 2, Aug. 2019, pp. 132–41. Pubmed, doi:10.1002/jso.25492.
Tamirisa N, Williamson HV, Thomas SM, Westbrook KE, Greenup RA, Plichta JK, Rosenberger LH, Hyslop T, Hwang E-SS, Fayanju OM. The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma. J Surg Oncol. 2019 Aug;120(2):132–141.
Journal cover image

Published In

J Surg Oncol

DOI

EISSN

1096-9098

Publication Date

August 2019

Volume

120

Issue

2

Start / End Page

132 / 141

Location

United States

Related Subject Headings

  • Survival Rate
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Invasiveness
  • Neoadjuvant Therapy
  • Middle Aged
  • Mastectomy
  • Male
  • Kaplan-Meier Estimate
  • Humans