P6-07-42
Patients with Nipple-areola Paget’s Disease and Underlying
Invasive Breast Carcinoma had a Very Poor Survival: a Matched
Cohort Study
Ling H, Xu X-L, Liu Z-B, Shao Z-M. Fudan University Shanghai
Cancer Center, Shanghai, China
[Purpose]
Nipple-areola Paget’s disease together with invasive breast cancer is
a rare kind of disease. This study is to investigate the characteristic
and survival of it.
[Patients]
From 2001 to 2005, all patients diagnosed as nipple-areola Paget’s
disease with underlying invasive breast carcinoma in Fudan
University Shanghai Cancer Center (FUSCC) were recruited in this
study (PD group).
www.aacrjournals.org 531s Cancer Res; 72(24 Suppl.) December 15, 2012
December 4-8, 2012 Abstracts: General Session 6
Patients diagnosed as invasive breast cancer without Paget’s disease
were recruited in control group for clinical and pathologic features
comparison.
Since tumors in PD group expressed more high risk factors (see
results), a matched study was done to investigate whether the poor
survival of PD group was by nature or due to the overexpression of
high risk factors. The matched group was derived from all the patients
who received mastectomy for invasive breast cancer (with no Paget’s
disease) during 2001 to 2005 in FUSCC. The match was conducted
according to four variables: dimension of tumor, lymph node status,
hormone receptor status and Her2 status. After matching, patients
were randomly selected in a 3:1 ratio to patients in PD group.
[Results]
52 patients were recruited in PD group. 22 (42.3%) patients’ primary
symptom were nipple change, 25 (48.1%) patients’ primary symptom
were mass in breast. Physical examination found no nipple-areola
change in 24 patients at diagnosis, their Paget’s disease were found
unexpectedly by routine nipple-areola section examination after
mastectomy.
More than 8000 invasive breast cancers were diagnosed during 2001
to 2005. 700 patients (140 consecutive patients per year, average
monthly patient amount) were recruited in control group. Compared
with control group, tumors in PD group had larger size, more axillary
lymph node involvement, lower hormone receptor expression, higher
HER2 expression and worse survival.
Comparison of Pathologic Features (Control Group) and Survival (Matched Group) with PD Group
PD group (n=52) Control Group (n=700) Matched Group (n=156)
Dimension ≤2cm 24 (46.2%) 423 (60.4%)∗ 72 (46.2%)
>2cm 28 (53.8%) 277 (39.6%) 84 (53.8%)
Lymph Node + 28 (53.8%) 250 (35.7%)∗ 84 (53.8%)
- 24 (46.2%) 450 (64.3%) 72 (46.2%)
Hormone receptor + 18 (34.6%) 488 (69.7%)∗ 54 (34.6%)
- 34 (65.4%) 212 (30.3%) 102 (65.4%)
Her2 + 40 (76.9%) 149 (21.3%)∗ 120 (76.9%)
- 12 (23.1%) 551 (78.7%) 36 (23.1%)
5y Relapse-Free Survival 52.2% 86.7%∗ 81.4%∗
5y Overall Survival 62.1% 91.8%∗ 85.9%∗
∗compared with PD group, P<0.05
156 patients were recruited in the matched group. The 5-year relapsefree
survival and overall survival were both lower for patients in PD
group than those in the matched group (table1).
[Conclusions]
Patients with invasive breast cancer and Paget’s disease tended to have
larger size, more lymph nodes involvement, lower hormone receptor
expression, higher HER2 expression and worse survival than those
without PD. The matched study confirmed the survival disadvantage
of patients with Paget’s disease and underlying invasive breast
cancer. Thus, oncologists should regard such patients as having high
risk for relapse. Pathologists should exam the nipple-areola section
carefully after mastectomy although the patient has no macroscopic
nipple-areola change.
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