Results
We identified 323 patients in this retrospective study, among them, 138
patients had AH at the margins in BCS, while 185 patients did not have
this pathological feature at the margins. The median follow-up was 48
months (range 13-117). The comparison of clinicopathological
characteristics and neoadjuvant chemotherapy response rate between the
two groups is presented in Table 1. Patients with AH or without AH did
not differ significantly by age, tumor histologic type, initial clinic T
stage, initial nodal stage, receptor status, post-NAC pathologic T
stage, post-NAC pathologic nodal status or overall pCR rate.
During the follow-up period, 8 (5.8%) patients in the AH group, and 8
(4.3%) patients in the non-AH group experienced ipsilateral breast
tumor recurrence (IBTR). The 5-year rates of IBTR were 6.7% (95% CI,
4.4%~9.0%) and 4.8% (95% CI,
3.1%~6.5%) in patinets with and without AH,
respectively. Distant-metastasis-free survival (DMFS) at 5 years was
86.3% (95% CI, 82.2%~90.4%) in the AH group, and
89.8% (95% CI,
87.4%~92.2%) in the non-AH group, respectively.
Additionally, the 5-years overall
survival (OS) rate of the patients with or without AH was 93.1% (95%
CI, 90.5%~95.7%) and
93.8% (95% CI,
91.7%~95.9%), respectively. No significant differences
were observed between the two groups of patients in terms of IBTR, DMFS,
or OS (p = 0.523, 0.461 and 0.328, respectively). Atypical
hyperplasia can be further classified into mild, moderate, and severe
categories which borders on ducal carcinoma in situ. Coopey et
al . evaluated breast cancer events in a retrospective cohort of 2938
women with ADH, ALH, LCIS, and severe ADH, and the 10 years risk of
breast cancer they estimated was 17% for women with ADH, 26 for women
with severe ADH16.
Therefore, severe atypical hyperplasia may be regarded as “higher level
of risk” lesion. We further analyzed the outcomes between patients with
severe atypical hyperplasia and those without atypical hyperplasia, and
no significant differences were found in IBTR, DMFS, or OS between
patients with severe atypical hyperplasia (n = 44) and those without
atypical hyperplasia (n = 185).
An overall pCR of breast and axillary nodes was achieved in 68 patients.
Patients who achieved an overall pCR had significantly better DMFS
(p = 0.022) and OS (p = 0.016), but not IBTR (p =
0.365), compared with those with residual disease. Among 255 patients
with residual disease after neoadjuvant chemotherapy, 37 patients
received re-excision due to invasive cancer and/or in situ carcinoma at
the primary margins, 63 patients received re-excision due to severe AH
which is somewhat difficult to distinguish from low grade DCIS in the
frozen section17. Among
these 63 patients, 16 still had severe AH after re-resection, and 3 of
these 16 patients experienced local recurrence, while 1 of 30 patients
without AH at re-excision margins had local recurrence, but again no
significantly difference between the two group of these 46 patients in
term of local recurrence in ipsilateral breast (p = 0.059).
It has been reported previously that some clinical, pathologic, and
molecular factors were associated with IBTR after
BCS4. Therefore, a
multivariate analysis was performed to assess these factors associated
with IBTR, DMFS and OS in our study. There was no association between
atypical hyperplasia status and IBTR in the multivariate analysis.
Similarly, other clinical and pathological features, including age,
tumor histologic type, initial clinic T stage, initial nodal stage,
receptor status, post-NAC pathologic T stage, post-NAC pathologic nodal
status or overall pCR rate, were not significantly associated with IBTR
as well. On multivariate analysis, patients who achieved pCR (p =
0.037, HR 4.6, 95% CI 1.09–19.18) had better DMFS, and patients who
had negative lymph nodes (p = 0.012, HR 4.8, 95% CI 1.41–16.79)
after NAC had better OS.