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Tan BY, Lim EH, Tan PH. Special Histologic Type and Rare Breast Tumors - Diagnostic Review and Clinico-Pathological Implications. Surg Pathol Clin 2022; 15:29-55. [PMID: 35236633 DOI: 10.1016/j.path.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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Zhang H, Zhang N, Moran MS, Li Y, Liang Y, Su P, Haffty BG, Yang Q. Special subtypes with favorable prognosis in breast cancer: A registry-based cohort study and network meta-analysis. Cancer Treat Rev 2020; 91:102108. [PMID: 33075683 DOI: 10.1016/j.ctrv.2020.102108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to explore whether cribriform and adenoid cystic carcinoma had comparable prognoses to mucinous, tubular and papillary carcinoma, which were long recognized as favorable histologies by NCCN guidelines. METHODS A retrospective analysis based on the Surveillance, Epidemiology, and End Results Study (SEER) database (1994-2014) was conducted. The prognostic significance of all clinicopathological factors was calculated using univariate and multivariate analyses. A systematic review based on PubMed and network meta-analysis was conducted. RESULTS From the SEER database, the histologic subtypes of breast cancer (tubular, cribriform, adenoid cystic, mucinous, and papillary) were sorted by overall survival (OS) (94.4%, 91.6%, 90.8%, 87.6%, and 84.2%, respectively) and tubular, cribriform, mucinous, papillary, and adenoid cystic carcinoma by breast cancer-specific survival (BCSS) (99.4%, 98.4%, 97.7%, 95.2%, and 94.9%, respectively). A network meta-analysis combining 11 studies (886,649 patients) was conducted, which demonstrated consistent outcomes. SEER-based analyses revealed that, among the favorable subtypes, systemic chemotherapy did not improve OS or BCSS in hormone receptor-positive, node-negative patients, validating that these subtypes are generally associated with excellent outcomes, for which systemic chemotherapy may not be warranted. CONCLUSIONS Our data are consistent with guidelines suggesting that the mucinous, tubular, and papillary subtypes of breast cancer have favorable histologies. SEER data and meta-analysis supports this favorable category to include adenoid cystic and cribriform carcinoma, whose OS and BCSS outcomes are comparable to the former three. These findings add to the body of data, suggesting that patients with these histologic subtypes confer excellent prognosis, which may guide optimal therapeutic management strategies.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, NJ, USA
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China; Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China.
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Abdelwahed A, Ahmed M. Rare epithelial breast cancer: surgery and adjuvant therapy. Transl Cancer Res 2019; 8:S479-S492. [PMID: 35117126 PMCID: PMC8797705 DOI: 10.21037/tcr.2019.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 01/30/2023]
Abstract
Breast cancer is a heterogenous disease, exhibiting a wide range of morphological phenotypes shaping its prognosis and clinical course. However, optimal management of rarer breast cancer subtypes is often undefined and controversial in literature due to the lack of large studies and randomised trials. This review aims to discuss the treatment of 13 rare epithelial subtypes, focussing on surgery and adjuvant therapies.
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Affiliation(s)
| | - Muneer Ahmed
- King's College London, Division of Cancer, Research Oncology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Chen JX, Zhang WW, Dong Y, Sun JY, He ZY, Wu SG. The effects of postoperative radiotherapy on survival outcomes in patients under 65 with estrogen receptor positive tubular breast carcinoma. Radiat Oncol 2018; 13:226. [PMID: 30458816 PMCID: PMC6247775 DOI: 10.1186/s13014-018-1177-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background The value of postoperative radiotherapy in tubular breast carcinoma patients under 65 years is uncertain. Methods Data on patients with estrogen receptor positive T1N0M0 tubular breast carcinoma who were younger than 65 years and who received breast-conserving surgery between 2000 and 2013 were retrieved from the Surveillance, Epidemiology and End Results database. Demographic, clinicopathologic features, and receipt of postoperative radiotherapy were analyzed to investigate effects on survival. Results Data from 2442 patients were analyzed, of whom 2020 (82.7%) received postoperative radiotherapy and 422 (17.3%) did not. The number of patients treated with or without postoperative radiotherapy showed no differences during the study period (p = 0.184). Radiotherapy was more likely to be administered in patients with well differentiated tumors. Multivariate Cox analysis showed that postoperative radiotherapy delivery was significantly correlated with better breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.297, 95% confidence interval [CI] 0.105–0.836, p = 0.022) and overall survival (OS) (HR 0.656, 95% CI 0.441–0.978, p = 0.038). Ten 10-year BCSS was 99.3% in patients who received postoperative radiotherapy and 98.1% in those who did not (p = 0.020), and 10-year OS was 93.4 and 91.0%, respectively (p = 0.029). Postoperative radiotherapy increased BCSS and OS in the subgroups of age < 50 years, non-Hispanic white, well differentiated tumors, and progesterone receptor positive tumors. Conclusions Postoperative radiotherapy after breast-conserving surgery improved survival outcomes in tubular breast carcinoma patients aged < 50 years. However, omitting postoperative radiotherapy may not decrease survival in patients aged ≥50 years.
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Affiliation(s)
- Jian-Xian Chen
- Department of Oncology, Division of Chemotherapy, the People's Hospital of Baise, Baise, 533000, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yong Dong
- Department of Oncology, the 3rd People's Hospital of Dongguan City, Dongguan, 523326, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
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Zhang WW, Wu SG, Ling YH, Sun JY, Long ZQ, Hua X, Dong Y, Li FY, He ZY, Lin HX. Clinicopathologic characteristics and clinical outcomes of pure type and mixed type of tubular carcinoma of the breast: a single-institution cohort study. Cancer Manag Res 2018; 10:4509-4515. [PMID: 30349383 PMCID: PMC6187920 DOI: 10.2147/cmar.s177046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction We aimed to evaluate the clinicopathologic characteristics and clinical outcomes of the mixed type versus the pure type of tubular carcinoma (TC) of the breast in a retrospective cohort study. Materials and methods Patients were categorized into the following three groups: patients with pure TC of the breast (the PTC group), patients with TC and carcinoma in situ of the breast (the TC-CIS group), and patients with TC and other invasive carcinomas of the breast (the TC-IC group). We compared the clinicopathologic characteristics and treatment outcomes of the three groups. The primary end point of this study was breast cancer-specific survival (BCSS). Secondary end points included distant metastasis-free survival (DMFS) and locoregional recurrence (LRR). Results A total of 68 patients were included in this study, including 31 patients in the PTC group, 12 in the TC-CIS group, and 25 in the TC-IC group. Our data showed that PTC and TC-CIS were more likely to be smaller in size (P=0.014) and had substantially less nodal involvement (P=0.019), compared with TC-IC. The median follow-up time was 64.3 months (range, 3.78–223.2 months) for all patients. No locoregional relapse was observed in any group during the follow-up period. The 10-year BCSS of the PTC, TC-CIS, and TC-IC groups was 100%, 100%, and 95.2%, respectively, and the 10-year DMFS was 92.3%, 100%, and 96.0%, respectively. There was no significant difference in terms of BCSS (P=0.53) or DMFS (P=0.84) between the three groups. Conclusion This study indicates that both the pure type and mixed type of TC of the breast show very low LRR and distant metastasis rate and have excellent survival. The TC-IC group is likely to show good prognosis similar to the PTC group. Further clinical trials with larger sample sizes as well as molecular and genetic studies are warranted.
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Affiliation(s)
- Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Yi-Hong Ling
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - Zhi-Qing Long
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - Xin Hua
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - Yong Dong
- Department of Radiation Oncology, the Third People's Hospital of Dongguan, Dongguan, Guangdong, People's Republic of China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
| | - Huan-Xin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China, ;
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Sun JY, Zhou J, Zhang WW, Li FY, He ZY, Wu SG. Tubular carcinomas of the breast: an epidemiologic study. Future Oncol 2018; 14:3037-3047. [PMID: 29989443 DOI: 10.2217/fon-2018-0385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We explored the clinicopathologic characteristics, prognostic factors and outcomes in tubular carcinoma (TC) of the breast. METHODS We retrospectively assessed 8091 TC patients using the SEER database from 2000 to 2013. RESULTS Most patients were non-Hispanic white, well-differentiated disease, tumor size ≤2 cm, node-negative, nonmetastatic, hormone receptor-positive and HER2-negative status. The 10-year breast cancer-specific survival and overall survival were 98.1 and 82.0%, respectively. Multivariate analysis indicated that age, ethnicity, surgery procedures, radiotherapy and chemotherapy were independent predictors affecting survival outcomes. There was comparable breast cancer-specific survival between surgery and nonsurgery groups. CONCLUSION The patients with TC has excellent survival outcomes, which may in part be due to the favorable tumor characteristics.
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Affiliation(s)
- Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Juan Zhou
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
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Wu SG, Zhang WW, Sun JY, Li FY, Chen YX, He ZY. Omission of Postoperative Radiotherapy in Women Aged 65 Years or Older With Tubular Carcinoma of the Breast After Breast-Conserving Surgery. Front Oncol 2018; 8:190. [PMID: 29900127 PMCID: PMC5988847 DOI: 10.3389/fonc.2018.00190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/14/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction To investigate the temporal trends of postoperative radiotherapy (RT) administration and the effects of omitting postoperative RT on breast cancer-specific survival (BCSS) in women aged ≥65 years with tubular carcinoma (TC) of the breast who received breast-conserving surgery (BCS). Methods We included women aged ≥65 years with non-metastatic TC of the breast who underwent BCS between 2000 and 2013 using the Surveillance, Epidemiology, and End Results database. Statistical analyses were performed using chi-square tests, Kaplan–Meier analyses, Cox proportional hazards models, and a 1:1 propensity score matching (PSM). Results Before PSM, a total of 1,475 patients with tumor size ≤2 cm, node-negative disease, and estrogen receptor-positive disease were identified, including 927 (62.8%) underwent postoperative RT and 548 (37.2%) had postoperative omission of RT. The administration of postoperative RT steadily declined over the study period. Patients with younger age, larger tumor size, and other race/ethnicity were more likely to receive postoperative RT. The median follow-up duration was 85.0 months, the 5- and 10-year BCSS rates were 98.7 and 97.9%, respectively. The median BCSS was 161.9 and 165.0 months for patients with and without postoperative RT, respectively, and the corresponding 5-year BCSS rates were 98.5 and 98.8%, respectively (p = 0.134). Prognostic analysis indicated that postoperative RT was not associated with improved BCSS rates compared with RT omission (p = 0.134). After PSM, a total of 431 complete pairs were generated. In the matched population, the 5-year BCSS rates were 98.6 and 98.4% in non-postoperative RT and postoperative RT groups, respectively (p = 0.858). The univariate analyses also confirmed that the administration of postoperative RT was not associated with better BCSS (p = 0.858). Conclusion The incidence of breast cancer-related death is probably sufficiently low to avoid postoperative RT in women aged ≥65 years with TC of the breast after BCS.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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Poirier É, Desbiens C, Poirier B, Boudreau D, Jacob S, Lemieux J, Doyle C, Diorio C, Hogue JC, Provencher L. Characteristics and long-term survival of patients diagnosed with pure tubular carcinoma of the breast. J Surg Oncol 2017; 117:1137-1143. [DOI: 10.1002/jso.24944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Éric Poirier
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Christine Desbiens
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Brigitte Poirier
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Dominique Boudreau
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
| | - Simon Jacob
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de biologie moléculaire; biochimie médicale et pathologie; Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Service de Pathologie; Hôpital du St-Sacrement; CHU de Québec; Quebec City QC Canada
| | - Julie Lemieux
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Médecine, Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Centre universitaire d'hématologie et d'oncologie de Québec; Quebec City QC Canada
| | - Catherine Doyle
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Médecine, Université Laval; Pavillon Ferdinand-Vandry; Quebec City QC Canada
- Centre universitaire d'hématologie et d'oncologie de Québec; Quebec City QC Canada
| | - Caroline Diorio
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
| | - Jean-Charles Hogue
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
| | - Louise Provencher
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec − Université Laval; Quebec City QC Canada
- Axe Oncologie; Centre de Recherche du CHU de Québec − Université Laval; Quebec City QC Canada
- Département de Chirurgie; Université Laval; Pavillon Ferdinand-Vandry Quebec City QC Canada
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Chen Z, Yang J, Li S, Lv M, Shen Y, Wang B, Li P, Yi M, Zhao X, Zhang L, Wang L, Yang J. Invasive lobular carcinoma of the breast: A special histological type compared with invasive ductal carcinoma. PLoS One 2017; 12:e0182397. [PMID: 28863134 PMCID: PMC5580913 DOI: 10.1371/journal.pone.0182397] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022] Open
Abstract
The clinical outcomes and therapeutic strategies for infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) are not uniform. The primary objectives of this study were to identify the differences in the clinical characteristics and prognoses between ILC and IDC, and identify the high-risk population based on the hormone receptor status and metastasis sites. The Surveillance, Epidemiology, and End Results Program database was searched and patients diagnosed with ILC or IDC from 1990 to 2013 were identified. In total,796,335 patients were analyzed, including 85,048 withILC (10.7%) and 711,287 withIDC (89.3%). The ILC group was correlatedwith older age, larger tumor size, later stage, lower grade, metastasis disease(M1) disease, and greater counts ofpositive lymph nodesandestrogen-receptor-positive (ER)/progesterone receptor-positive (PR) positive nodes. The overall survival showed an early advantage for ILC but a worse outcome after 5 years. Regarding the disease-specific survival, the IDC cohort had advantages over the ILC group, both during the early years and long-term. In hormone status and metastasis site subgroup analyses, the ER+/PR+ subgroup had the best survival, while the ER+/PR- subgroup had the worst outcome, especially the ILC cohort. ILC and IDC had different metastasis patterns. The proportion of bone metastasis was higher in the ILC group (91.52%) than that in the IDC (76.04%), and the ILC group was more likely to have multiple metastasis sites. Survival analyses showed patients with ILC had a higher risk of liver metastasis (disease-specific survival[DSS]; P = 0.046), but had a better overall survival than the bone metastasis group (P<0.0001). We concluded that the long-term prognosis for ILC was poorer than that for IDC, and the ER+/PR- subgroup had the worst outcome. Therefore, the metastasis pattern and prognosis must be seriously evaluated, and a combination of endocrine therapy and chemotherapy should be considered.
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Affiliation(s)
- Zheling Chen
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yanwei Shen
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Biyuan Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Pan Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Min Yi
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Xiao’ai Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Lingxiao Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Le Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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