Prognostic significance of mammary Paget’s disease in Chinese women: a 10 year, population-based, matched cohort study
Authors Zhou H, Lu K, Zheng L, Guo L, Gao Y, Miao X, Chen Z, Wang X
Received 20 April 2018
Accepted for publication 24 August 2018
Published 23 November 2018 Volume 2018:11 Pages 8319—8326
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr William Cho
Huanhuan Zhou,1 Kongbeng Lu,2 Lei Zheng,1 Liwei Guo,3 Yun Gao,1 Xianyuan Miao,1 Zhanhong Chen,1 Xiaojia Wang1
1Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Medical Oncology, Shaoxing Second Hospital, Shaoxing, Zhejiang, People’s Republic of China; 3State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
Purpose: To explore the prognostic significance of mammary Paget’s disease (PD) in breast cancer (BC) patients and to investigate the association between clinical manifestation and outcome in invasive ductal carcinoma patients with PD (PD-IDC).
Patients and methods: Eighty-five patients diagnosed with mammary PD with underlying BC from 2006 to 2012 at Zhejiang Cancer Hospital were recruited. A matched group comprised 85 patients diagnosed with BC without PD. Patients were matched according to four variables: stage (0–IV), age at diagnosis (within 5 years), histologic subtype, and the year of surgery. The 74 patients diagnosed with PD-IDC were divided into three groups based on their clinical presentation.
Results: Compared with the matched group, the PD group had more HER2 positivity (P<0.01) and hormone receptor negativity (P<0.01), and a worse outcome (Kaplan–Meier analysis, P<0.001 for disease-free survival and P=0.002 for overall survival). Multivariate Cox regression analyses showed that PD was an independent prognostic predictor for BC patients with PD. In addition, the 22 PD-IDC patients who presented with skin lesions in the nipple/areola and a mass in the breast or axilla had a higher risk of disease relapse than patients who presented with a mass in the breast without skin lesions or patients who presented with skin changes without a palpable mass (adjusted hazards ratio, 0.24; 95% CI, 0.08–0.73; P=0.012 and adjusted hazard ratio, 0.30; 95% CI, 0.06–1.40; P=0.124, respectively).
Conclusion: PD is an independent prognostic indicator of outcome in BC patients with PD. Furthermore, the primary symptoms at presentation may be an available indicator of prognosis in PD-IDC.
Keywords: Paget’s disease, invasive ductal carcinoma, prognosis, clinical presentation
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