Advertisement

Breast Cancer Research and Treatment

, Volume 133, Issue 2, pp 713–723 | Cite as

Invasive lobular breast cancer: subtypes and outcome

  • Monica IorfidaEmail author
  • Eugenio Maiorano
  • Enrico Orvieto
  • Patrick Maisonneuve
  • Luca Bottiglieri
  • Nicole Rotmensz
  • Emilia Montagna
  • Silvia Dellapasqua
  • Paolo Veronesi
  • Viviana Galimberti
  • Alberto Luini
  • Aron Goldhirsch
  • Marco Colleoni
  • Giuseppe Viale
Clinical Trial

Abstract

Invasive lobular carcinoma (ILC) is the most common “special type” of breast cancer. Although conflicting literature data are available on the outcome of ILC, recently reported data indicate that ILC carries a poorer prognosis if compared to invasive ductal carcinomas. We evaluated clinical and biological features of 981 consecutive patients with pT1-3, pN1-3 M0 ILC. Median follow-up was 7.4 years for survival. A total of 541 patients were classified as classic (55.8%), 146 alveolar (14.9%), 145 mixed non-classic (14.8%), 104 solid (10.6%), and 38 trabecular (3.9%). A statistically significant difference in the outcome was observed at multivariate analysis for patients with solid (HR 2.44, 95% CI 1.39–4.29 for OS; HR 1.92, 95% CI 1.29–2.88 for DFS) and mixed non-classic (HR 1.99, 95% CI 1.12–3.53 for OS) versus patients with classical ILC. A statistically significant difference in the risk of distant metastases was observed at multivariate analysis for patients with Luminal B (HR 2.56, 95% CI 1.38–4.76), HER2 positive (HR 7.80, 95% CI 1.55–39.3), and triple negative (HR 7.61, 95% CI 2.63–22.1) subtypes versus patients with Luminal A ILC. Age ≥70 years, tumor size and degree of nodal involvement were additional independent predictors of reduced overall survival. The outcome of ILC significantly correlated with histological and immunohistochemically defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.

Keywords

Breast cancer Lobular carcinoma Histological subtypes Outcome 

Notes

Conflict of interest

The authors declare no conflict of interest related to this study.

References

  1. 1.
    Li CI, Anderson BO, Daling JR et al (2003) Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA 289:1421–1424PubMedCrossRefGoogle Scholar
  2. 2.
    Li CI, Anderson BO, Porter P et al (2000) Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer 88:2561–2569PubMedCrossRefGoogle Scholar
  3. 3.
    Abdel-Fatah TM, Powe DG, Hodi Z, Reis-Filho JS, Lee AH, Ellis IO (2008) Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol 32:513–523PubMedCrossRefGoogle Scholar
  4. 4.
    Weigelt B, Geyer FC, Natrajan R et al (2010) The molecular underpinning of lobular histological growth pattern: a genome-wide transcriptomic analysis of invasive lobular carcinomas and grade- and molecular subtype-matched invasive ductal carcinomas of no special type. J Pathol 220:45–57PubMedCrossRefGoogle Scholar
  5. 5.
    Pestalozzi BC, Zahrieh D, Mallon E et al (2008) Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: combined results of 15 international breast cancer study group clinical trials. J Clin Oncol 26:3006–3014PubMedCrossRefGoogle Scholar
  6. 6.
    Dixon JM, Anderson TJ, Page DL et al (1982) Infiltrating lobular carcinoma of the breast. Histopathology 6:149–161PubMedCrossRefGoogle Scholar
  7. 7.
    du Toit RS, Locker AP, Ellis IO et al (1991) An evaluation of differences in prognosis, recurrence patterns and receptor status between invasive lobular and other invasive carcinomas of the breast. Eur J Surg Oncol 17:251–257PubMedGoogle Scholar
  8. 8.
    DiCostanzo D, Rosen PP, Gareen I et al (1990) Prognosis in infiltrating lobular carcinoma. An analysis of “classical” and variant tumors. Am J Surg Pathol 14:12–23PubMedCrossRefGoogle Scholar
  9. 9.
    Orvieto E, Maiorano E, Bottiglieri L et al (2008) Clinicopathologic characteristics of invasive lobular carcinoma of the breast: results of an analysis of 530 cases from a single institution. Cancer 113(7):1511–1520PubMedCrossRefGoogle Scholar
  10. 10.
    Ellis IO, Schnitt SJ, Sartre-Garau X et al (2003) Invasive breast carcinoma. In: Tavassoli FA, Devilee P (eds) World Health Organization classification of tumors. Pathology and genetics of tumors of the breast and female genital organs. IARC Press, Lyon, pp 23–26Google Scholar
  11. 11.
    Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410PubMedCrossRefGoogle Scholar
  12. 12.
    Cristofanilli M, Gonzalez-Angulo A, Sneige N et al (2005) Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23:41–48PubMedCrossRefGoogle Scholar
  13. 13.
    Cocquyt VF, Blondeel PN, Depypere HT et al (2003) Different responses to preoperative chemotherapy for invasive lobular and invasive ductal breast carcinoma. Eur J Surg Oncol 29:361–367PubMedCrossRefGoogle Scholar
  14. 14.
    Chaturvedi S, Heys SD, Chaturvedi RS (2004) Primary chemotherapy for breast cancers: does histological type of cancer matter? Breast Cancer Res Treat 88:S106 (abstr 2089)Google Scholar
  15. 15.
    Pu RT, Schott AF, Sturtz DE, Griffith KA, Kleer CG (2005) Pathologic features of breast cancer associated with complete response to neoadjuvant chemotherapy: importance of tumor necrosis. Am J Surg Pathol 29:354–358PubMedCrossRefGoogle Scholar
  16. 16.
    Vincent-Salomon A, Pierga J-Y, Gautier C (2005) Neoadjuvant chemotherapy for invasive lobular carcinoma of the breast: a poorer response rate but not a worse prognosis than invasive ductal carcinoma. Breast Cancer Res Treat 94:S231 (abstr 5071)Google Scholar
  17. 17.
    Toikkanen S, Pylkkanen L, Joensuu H (1997) Invasive lobular carcinoma of the breast has better short- and long-term survival than invasive ductal carcinoma. Br J Cancer 76:1234–1240PubMedCrossRefGoogle Scholar
  18. 18.
    Eusebi V, Magalhaes F, Azzopardi JG (1992) Pleomorphic lobular carcinoma of the breast: an aggressive tumor showing apocrine differentiation. Hum Pathol 23:655–662PubMedCrossRefGoogle Scholar
  19. 19.
    Buchanan CL, Flynn LW, Murray MP et al (2008) Is pleomorphic lobular carcinoma really a distinct clinical entity? J Surg Oncol 98:314–317PubMedCrossRefGoogle Scholar
  20. 20.
    Cheang MC, Chia SK, Voduc D et al (2009) Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 101(10):736–750PubMedCrossRefGoogle Scholar
  21. 21.
    Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer. Ann Oncol 22(8):1736–1747PubMedCrossRefGoogle Scholar
  22. 22.
    Arpino G, Bardou VJ, Clark GM et al (2004) Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res 6:R149–R156PubMedCrossRefGoogle Scholar
  23. 23.
    Gonzalez-Angulo AM, Sahin A, Krishnamurthy S et al (2006) Biologic markers in axillary node-negative breast cancer: differential expression in invasive ductal carcinoma versus invasive lobular carcinoma. Clin Breast Cancer 7:396–400PubMedCrossRefGoogle Scholar
  24. 24.
    Tubiana-Hulin M, Stevens D, Lasry S et al (2006) Response to neoadjuvant chemotherapy in lobular and ductal breast carcinomas: a retrospective study on 860 patients from one institution. Ann Oncol 17:1228–1233PubMedCrossRefGoogle Scholar
  25. 25.
    Rakha EA, El-Sayed ME, Powe DG et al (2008) Invasive lobular carcinoma of the breast: response to hormonal therapy and outcomes. Eur J Cancer 44:73–83PubMedCrossRefGoogle Scholar
  26. 26.
    Mersin H, Yildirim E, Gulben K et al (2003) Is invasive lobular carcinoma different from invasive ductal carcinoma? Eur J Surg Oncol 29:390–395PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Monica Iorfida
    • 1
    Email author
  • Eugenio Maiorano
    • 2
  • Enrico Orvieto
    • 3
  • Patrick Maisonneuve
    • 4
  • Luca Bottiglieri
    • 5
  • Nicole Rotmensz
    • 4
  • Emilia Montagna
    • 1
  • Silvia Dellapasqua
    • 1
  • Paolo Veronesi
    • 6
    • 7
  • Viviana Galimberti
    • 8
  • Alberto Luini
    • 9
  • Aron Goldhirsch
    • 10
    • 11
  • Marco Colleoni
    • 1
  • Giuseppe Viale
    • 5
  1. 1.Research Unit in Medical Senology, Department of MedicineEuropean Institute of OncologyMilanItaly
  2. 2.Department of PathologyUniverisity of Bari “Aldo Moro”BariItaly
  3. 3.Surgical Pathology and Cytopathology UnitUniversity of PadovaPaduaItaly
  4. 4.Division of Epidemiology and BiostatisticsEuropean Institute of OncologyMilanItaly
  5. 5.Division of Pathology and Laboratory MedicineEuropean Institute of Oncology, University of MilanMilanItaly
  6. 6.Integrated Breast Surgery UnitEuropean Institute of OncologyMilanItaly
  7. 7.School of MedicineUniversity of MilanMilanItaly
  8. 8.Unit of Molecular SenologyEuropean Institute of OncologyMilanItaly
  9. 9.Division of SenologyEuropean Institute of OncologyMilanItaly
  10. 10.Department of MedicineEuropean Institute of OncologyMilanItaly
  11. 11.Oncology Institute of Southern SwitzerlandBellinzonaSwitzerland

Personalised recommendations