Patients with early-stage papillary BCA are less likely to receive lumpectomy + XRT compared with IDC, although lumpectomy + XRT was associated with superior OS.
Mohamad H. Fakhreddine, MD, Vatsal Patel, MD, MBA, Awad Ahmed, MD, Arnold Paulino, MD, Mary Schwartz, MD, Angel Rodriguez, MD, Bin Teh, MD; UT Health Science Center at San Antonio; University of Miami; UT MD Anderson Cancer Center; Houston Methodist Hospital
BACKGROUND: Papillary breast cancer (BCA) histology, representing 0.5% of invasive BCA, is considered favorable; clinicians may treat early stages less aggressively. This study reports prognostic factors, outcomes, and treatment differences with invasive ductal carcinoma (IDC).
PATIENTS AND METHODS: Papillary cases, limited to stages T1–2 N0, were identified in the latest Surveillance, Epidemiology, and End Results (SEER) Registry 18. Univariate and multivariate analyses (UVA, MVA) were performed using variables of treatment, stage, race, estrogen receptor (ER)/progesterone receptor (PR) status, grade (G1–3), and age. Treatment included lumpectomy, lumpectomy with radiation (XRT), and mastectomy.
Treatment differences between papillary disease and IDC were analyzed during the last 5 years available in SEER (2007–2011).
RESULTS: Among 10,485 papillary cases, the median follow-up was 56 months, the median age was 53.0 years, and the 5-year and 10-year overall survival (OS) rates were 93.1% and 76.8%, respectively. Mastectomy represented 69.9% of cases vs 20.8% with lumpectomy and 9.3% for lumpectomy + XRT. Lumpectomy + XRT patients were oldest (mean age: 58.5 yr); mastectomy patients were youngest (mean age: 52.7 yr). Patients treated with lumpectomy alone had a higher proportion of T1 (89.9%; P < .0001) and G1 disease (58.1%; P < .0001).
On UVA, patients treated with lumpectomy + XRT had superior OS, with a mean of 16.8 years (14.9 yr for mastectomy; 14.2 yr for lumpectomy alone; P = .0003). Improved OS correlated with lower tumor grade (P < .0001) and lower T stage (P < .0001). Blacks had the lowest mean OS (12.7 yr; P < .0001). ER/PR status was not significant. MVA with Cox proportional hazards demonstrated treatment, age, tumor stage, race, and tumor grade to be significant. Lumpectomy + XRT had the lowest hazard ratio ([HR], 0.66; P = .0001). Lumpectomy alone and mastectomy had equivalent HRs. Worse OS was associated with higher T stage (HR, 1.46; P < .0001), G3 disease (HR, 1.46; P = .0009), and black race (HR, 1.40; P = .0003). From 2007 to 2011, papillary patients were treated with more mastectomies (79.8% vs 31.0%) and less lumpectomy + XRT (3.83% vs 52.71%; P < .0001).
CONCLUSIONS: Patients with early-stage papillary BCA are less likely to receive lumpectomy + XRT compared with IDC, although lumpectomy + XRT was associated with superior OS.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org