Invasive lobular carcinoma of the breast; clinicopathologic profile and response to neoadjuvant chemotherapy over a 15-year period

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY Breast Pub Date : 2024-05-01 DOI:10.1016/j.breast.2024.103739

N.P. Quirke , C. Cullinane , M.A. Turk , N. Shafique , D. Evoy , J. Geraghty , D. McCartan , C. Quinn , J.M. Walshe , E. McDermott , C. Rutherford , R.S. Prichard

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Abstract

Introduction

Invasive lobular carcinoma (ILC) accounts for 5–15% of invasive breast cancers. Typical ILC is oestrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative. Atypical biomarker profiles (ER- and HER2+, ER+ and HER2+ or triple negative) appear to differ from typical ILCs. This study compared subtypes of ILC in terms of clinical and pathological parameters, and response to neoadjuvant chemotherapy (NACT) according to biomarker profile.

Methods

All patients with ILC treated in a single centre from January 2005 to December 2020 were identified from a prospectively maintained database. Clinicopathologic and outcome data was collected and analysed according to tumour biomarker profile.

Results

A total of 582 patients with ILC were treated. Typical ILC was observed in 89.2% (n = 519) and atypical in 10.8% (n = 63). Atypical ILCs were of a higher grade (35% grade 3 vs 9.6% grade 3, p < 0.001).

A larger proportion of atypical ILC received NACT (31.7% vs 6.9% p < 0.001). Atypical ILCs showed a greater response to NACT (mean RCB (Residual Cancer Burden Score) 2.46 vs mean RCB 3.41, p = 0.0365), and higher pathological complete response rates (15% vs 0% p = 0.017). Despite this, overall 5-year disease-free survival (DFS) was higher in patients with typical ILC (91% vs 83%, p = 0.001).

Conclusions

Atypical ILCs have distinct characteristics. They are more frequently of a higher grade and demonstrate a superior response to NACT. Despite the latter, atypical ILCs have a worse 5-year DFS which should be taken into consideration in terms of prognostication and may assist patient selection for NACT.

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浸润性乳腺小叶癌；15 年间的临床病理学特征和对新辅助化疗的反应

导言浸润性小叶癌（ILC）占浸润性乳腺癌的5-15%。典型的浸润性小叶癌雌激素受体（ER）阳性，人类表皮生长因子受体2（HER2）阴性。非典型生物标志物特征（ER-和HER2+、ER+和HER2+或三阴性）似乎与典型的ILC不同。本研究根据生物标志物特征比较了ILC亚型的临床和病理参数以及对新辅助化疗（NACT）的反应。结果共有582名ILC患者接受了治疗。89.2%的患者为典型ILC（519例），10.8%的患者为非典型ILC（63例）。非典型 ILC 的分级更高（35% 为 3 级，9.6% 为 3 级，p < 0.001），接受 NACT 治疗的非典型 ILC 比例更高（31.7% 为 6.9%，p < 0.001）。非典型ILC对NACT的反应更大（平均RCB（残余癌负担评分）2.46 vs 平均RCB 3.41，p = 0.0365），病理完全反应率更高（15% vs 0% p = 0.017）。尽管如此，典型 ILC 患者的总体 5 年无病生存率（DFS）较高（91% vs 83%，P = 0.001）。结论非典型 ILC 具有独特的特征，它们的分级更高，对 NACT 的反应更佳。尽管如此，非典型 ILCs 的 5 年 DFS 较差，这一点应在预后方面加以考虑，并有助于选择 NACT 患者。

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.