Abstract
BackgroundMost mammary Paget disease (MPD) is associated with underlying in situ or invasive breast cancer. The objective of this study was to compare the clinicopathological characteristics and survival outcomes between breast cancer with Paget disease (PD) and breast cancer alone.MethodsFrom the Surveillance, Epidemiology, and End Results (SEER) database, 2000‐2015, of the US National Cancer Institute, we identified 1569 women who had PD with invasive ductal carcinoma (PD‐IDC) and 1489 women who had PD with ductal carcinoma in situ (PD‐DCIS). Independent demographic and clinicopathological variables as well as survival outcomes of these patients were compared to patients with the corresponding breast cancer without concomitant PD.ResultsPD‐IDC and PD‐DCIS both had worse survival outcomes and poorer tumor characteristics than the corresponding disease without PD. Contrary to in the breast cancer alone groups, in the breast cancer with PD groups, the HR status (P = 0.182 in PD‐IDC and P = 0.371 in PD‐DCIS), HER2 status (P = 0.788 in PD‐IDC and P = 0.643 in PD‐DCIS), and combined molecular subtype (P = 0.196 in PD‐IDC and P = 0.853 in PD‐DCIS) were not found to affect disease prognosis. After matching tumor characteristics and treatment approaches, PD‐IDC as well as PD‐DCIS exhibited no significant difference in disease prognosis with corresponding IDC and DCIS. Finally, by comparative analysis, a kind of PD‐DCIS (ICD‐O‐3 code 8543/3) showed many invasive behaviors (31.8% of 8543/3 patients had stage I‐III cancer) and was associated with worse survival outcomes than the other type of PD‐DCIS.ConclusionsBreast cancer with concomitant PD was associated with more aggressive tumor characteristics and worse survival outcomes. The HR status, HER2 status, and combined molecular subtype could not affect the prognosis of breast cancer with PD. Moreover, a portion of the PD‐DCIS cases were invasive breast cancer cases that required special treatment.
Highlights
Paget disease (PD) is a rare cutaneous adenocarcinoma that targets mainly the nipple‐areola complex (NAC) of the breast as well as the genital and perianal skin.[1]
Studies showed that approximately 82%‐100% of mammary Paget disease (MPD) cases are associated with underlying in situ or invasive breast cancer,[2] and this observation supports the most accepted pathogenesis theory, which posits that Paget cells are ductal carcinoma cells that have migrated from the underlying ducts to the epidermis.[3,4]
Our findings suggest that PD‐Paget disease with ductal carcinoma in situ (DCIS) and PD‐invasive ductal carcinoma (IDC) have poor tumor characteristics, including high‐histological grades, advanced American Joint Committee on Cancer (AJCC) stages, low hormone receptor (HR)‐positive ratios, and high human epidermal receptor‐2 (HER2)‐positive ratios
Summary
Paget disease (PD) is a rare cutaneous adenocarcinoma that targets mainly the nipple‐areola complex (NAC) of the breast as well as the genital and perianal skin.[1] It is named after Sir James Paget, who reported that all of his patients developed breast cancer within 2 years after nipple changes was observed. Little is known about PD‐DCIS clinicopathologic features and survival outcomes, especially the differences in these characteristics compared with those of DCIS alone.[11]. Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 2000‐2015, of the US National Cancer Institute, we identified 1569 women who had PD with invasive ductal carcinoma (PD‐IDC) and 1489 women who had PD with ductal carcinoma in situ (PD‐DCIS). After matching tumor characteristics and treatment approaches, PD‐IDC as well as PD‐DCIS exhibited no significant difference in disease prognosis with corresponding IDC and DCIS. A portion of the PD‐DCIS cases were invasive breast cancer cases that required special treatment
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