Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit
Invasive lobular carcinomas (ILCs) represent approximately 10% of all breast cancers. Despite this high frequency, benefit of adjuvant chemotherapy (CT) is still unclear.
Our objective was to investigate the impact of CT on survival in ILC. Patients were retrospectively identified from a cohort of 23,319 patients who underwent primary surgery in 15 French centers between 1990 and 2014. Only ILC, hormone-positive, human epidermal growth factor 2 (HER2)-negative patients who received adjuvant endocrine therapy (ET) were included. End-points were disease-free survival (DFS) and overall survival (OS). A propensity score for receiving CT, aiming to compensate for baseline characteristics, was used.
Of a total of 2318 patients with ILC, 1485 patients (64%) received ET alone and 823 (36%) received ET + CT. We observed a beneficial effect of addition of CT to ET on DFS and OS in multivariate Cox model (HR = 0.61, 95% confidence interval, CI [0.41–0.90]; p = 0.01 and 0.52, 95% CI [0.31–0.87]; p = 0.01, respectively). This effect was even more pronounced when propensity score matching was used. Regarding subgroup analysis, low-risk patients without CT did not have significant differences in DFS or OS compared to low-risk patients with CT.
ILC patients could derive significant DFS and OS benefits from CT, especially for high-risk patients.
KeywordsAdjuvant chemotherapy Breast cancer Lobular Hormone receptor-positive
Human epidermal growth factor 2
Invasive duct carcinoma of no special type
Invasive lobular carcinoma
Scarff, Bloom, and Richardson
This academic work did not receive financial support from any funding source.
AN, CJ, AG, and GH contributed to literature search, figures, study design, data analysis, data interpretation, and writing. All authors have participated in the data collection. All authors have critically reviewed the final version of the manuscript and approved its content. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Conceptualization AN, CJ, AG, GH. Data curation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Formal analysis AN, CJ, AG, GH. Investigation AN, CJ, AG, GH. Methodology AN, CJ, AG, GH. Project administration AN. Supervision AG, GH. Validation AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Visualization AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH. Writing AN, CJ, AG, GH. Review and editing AN, CJ, AG, JMC, MC, FR, CM, MPC, NC, PEC, EJ, ED, RR, CC, PG, ASA, CT, EL, GH.
Compliance with ethical standards
Conflict of interest
Authors have nothing to disclose.
All procedures performed in this study involving human participants were done in accordance with the French Ethical Standards and with the 2008 Helsinki Declaration. As this was a retrospective non-interventional study, no formal personal consent was required.
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