Details

Autor(en) / Beteiligte

• Metzger-Filho, Otto
• Ferreira, Arlindo
• Jeselsohn, Rinath
• Barry, William T.
• Dillon, Deborah A.
• Brock, Jane E.
• Vaz-Luis, Ines
• Hughes, Melissa E.
• Winer, Eric P.
• Lin, Nancy U.

Titel

Mixed invasive ductal and lobular carcinoma of the breast: prognosis and the importance of histologic grade

Ist Teil von

• The oncologist (Dayton, Ohio), 2019-07, Vol.24 (7), p.e441-e449

Ort / Verlag

Hoboken, USA: Oxford University Press

Erscheinungsjahr

2019

Quelle

Access via Wiley Online Library

Beschreibungen/Notizen

• © AlphaMed Press 2018. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Background: The diagnosis of mixed invasive ductal and lobular carcinoma (IDC-L) in clinical practice is often associated with uncertainty related to its prognosis and response to systemic therapies. With the increasing recognition of invasive lobular carcinoma (ILC) as a distinct disease subtype, questions surrounding IDC-L become even more relevant. In this study, we took advantage of a detailed clinical database to compare IDC-L and ILC regarding clinicopathologic and treatment characteristics, prognostic power of histologic grade, and survival outcomes. Materials and methods: In this retrospective cohort study, we identified 811 patients diagnosed with early-stage breast cancer with IDC-L or ILC. Descriptive statistics were performed to compare baseline clinicopathologic characteristics and treatments. Survival rates were subsequently analyzed using the Kaplan-Meier method and compared using the Cox proportional hazards model. Results: Patients with ILC had more commonly multifocal disease, low to intermediate histologic grade, and HER2-negative disease. Histologic grade was prognostic for patients with IDC-L but had no significant discriminatory power in patients with ILC. Among postmenopausal women, those with IDC-L had significantly better outcomes when compared with those with ILC: disease-free survival (DFS) and overall survival (OS; adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.31-0.95). Finally, postmenopausal women treated with an aromatase inhibitor had more favorable DFS and OS than those treated with tamoxifen only (OS adjusted HR, 0.50; 95% CI, 0.29-0.87), which was similar for both histologic types (p = .212). Conclusion: IDC-L tumors have a better prognosis than ILC tumors, particularly among postmenopausal women. Histologic grade is an important prognostic factor in IDC-L but not in ILC. Implications for practice: This study compared mixed invasive ductal and lobular carcinoma (IDC-L) with invasive lobular carcinomas (ILCs) to assess the overall prognosis, the prognostic role of histologic grade, and response to systemic therapy. It was found that patients with IDC-L tumors have a better prognosis than ILC, particularly among postmenopausal women, which may impact follow-up strategies. Moreover, although histologic grade failed to stratify the risk of ILC, it showed an important prognostic power in IDC-L, thus highlighting its clinical utility to guide treatment decisions of IDC-L. Finally, the disease-free survival advantage of adjuvant aromatase inhibitors over tamoxifen in ILC was consistent in IDC-L. This work was supported by the Susan G. Komen Foundation for the Cure (Grant PDF14302599), Fundação para a Ciência e a Tecnologia (Grant HMSP-ICJ/0007/2013 under the Harvard Medical School Portugal program), and the Maor Foundation.