The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecu
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ORIGINAL ARTICLE
The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecular subtypes of the breast Hengqiang Zhao1 Received: 20 April 2020 / Accepted: 12 August 2020 © The Japanese Breast Cancer Society 2020
Abstract Background To investigate the prognosis of females with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and mixed invasive ductal and lobular carcinoma (IDLC) according to hormone receptor (HR) and HER2 status. Methods Data of 171,881 patients from the SEER database were analyzed. Propensity score matching was used to balance the covariates. Breast cancer-specific survival (BCSS) and overall survival (OS) of IDC, ILC, and IDLC were investigated. Results Patients with ILC were older, had lower tumor grade, higher tumor stage, larger tumor size, more nodal metastasis, higher estrogen receptor(+), lower HER2(−), and less likely to receive partial mastectomy and chemotherapy compared with IDC and IDLC. ILC and IDLC showed better prognosis than IDC after matching by Kaplan–Meier curves. Multivariate Cox regression showed better OS of ILC and IDLC compared with IDC with hazard ratio and a 95% confidence interval of 0.84 (0.77–0.90) and 0.91 (0.83–1.00), respectively. For HR(+)HER2(−) subgroup, ILC showed better OS than IDC; IDC showed worse BCSS and OS than IDLC. For HR(+)HER2(+); ILC showed better OS compared with IDLC; there were no survival differences of IDC, ILC, and IDLC for HER2(+). For HR(−)HER2(−), ILC and IDC showed better BCSS and OS compared with IDLC by multivariate analysis. Conclusions The prognoses of female patients with IDC, ILC or IDLC were associated with the molecular subtypes of breast carcinoma. Management decisions should be based on pathological types and molecular subtypes. Keywords Breast · Invasive ductal carcinoma · Lobular carcinoma · Molecular subtypes · Prognosis · SEER database
Introduction Breast cancer is a heterogeneous disease with many subtypes [1]. Of these distinct histological types, invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) account for 70–80% and 5–15% of all invasive breast cancers, respectively [2]. The clinicopathologic characteristics between IDC and ILC have been well described. ILC was more likely to be multifocal, positive for estrogen receptor (ER), negative for human epidermal growth factor receptor-2 (HER2), Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12282-020-01146-4) contains supplementary material, which is available to authorized users. * Hengqiang Zhao [email protected] 1
Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
and present with axillary lymph nodes metastasis compared with IDC [3]. Previous studies have shown that ILC tends to show the same, better, or worse prognosis than IDC [3–9]. Three to 5% of tumors show mixed ductal and lobular morphology if the ductal component comprises 10–49% of the tumor and the lobular
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