Date of Award

10-19-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Meena Moran MD

Abstract

Purpose: The purpose of our study is to evaluate our institutional experience of treating Tubular Carcinoma of the Breast (TC) and Invasive Ductal Carcinoma (IDC) with Breast Conservation Therapy (BCT), consisting of conservative surgery (CS) and radiation therapy (RT), and to compare clinical-pathologic features and long-term outcomes. Materials and Methods: A review of our institutions tumor registry from 1975-2007 was performed, followed by a central pathology review of available slides, yielding 71 cases of Stage I/II TC and 2238 cases of Stage I/II IDC treated with BCT. Results: Clinical-pathologic features and outcomes were then analyzed by subtype to detect significant differences. The median follow-up was 7 years. The TC cohort presented more frequently with pT1 disease (97% vs. 80%, p=0.0007), pN0 disease (95% vs. 74%, p=0.0004), hormone-receptor positivity (ER+: 89% vs. 62%, p=0.0001; PR+: 81% vs. 52%, p=0.0001), and HER-2 negativity (89% vs. 71%, p= 0.04). Clinical outcomes also favored the TC cohort, with lower rates of breast cancer-related death (1% vs. 10%; p = 0.0109) and distant metastasis (1% vs. 13%; p = 0.0028), and higher rates of 10-year overall (90% vs. 80%; p=0.033), cause-specific (99% vs. 86%; p=0.011), and disease-free (99% vs. 82%; p=0.003) survival. There was a non-significant trend towards improved breast relapse-free survival for the TC cohort (95% vs. 87%; p=0.062) but no difference in nodal relapse-free survival or contralateral breast relapse-free survival (all p-values > 0.05) between the cohorts. Conclusion: Our institutional experience suggests that TC, when compared to IDC, is associated with more favorable clinical-pathologic features and comparable, if not superior, outcomes following BCT, suggesting the appropriateness of a conservative approach to this rare subtype.

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