Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit

Nonneville, Alexandre de; Jauffret, Camille; Gonçalvès, Anthony; Classe, Jean‐Marc; Cohen, Monique; Reyal, Fabien; Mazouni, Chafika; Chauvet, Marie‐Pierre; Chopin, Nicolás; Colombo, Pierre‐Emmanuel; Jouve, Eva; Daraı̈, Émile; Rouzier, Roman; Coutant, Charles; Gimbergues, Pierre; Azuar, Anne-Sophie; Lara, C. Tunon de; Lambaudie, Éric; Houvenaeghel, Gilles

doi:10.1007/s10549-019-05160-9

Cited by 22 publications

(33 citation statements)

References 29 publications

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“…Adjuvant chemotherapy may not improve survival for patients with HR(+)HER2(−) T1b-c/ N0-1/M0 ILC [18]. However, ILC patients could derive significant disease-free survival and OS benefits from chemotherapy, especially for high-risk patients [19]. ILC can be treated similarly to IDC with surgery followed by radiation, and hormone therapy is also important given the high proportions of patients positive for ER and PR.…”

Section: Discussionmentioning

confidence: 99%

The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecular subtypes of the breast

Zhao

2020

Breast Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecular subtypes of the breast

Zhao

2020

Breast Cancer

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“…Marmor et al (41) also reported a similar result in patients with ER-positive, HER2-negative, stage I/II ILC who received endocrine therapy, demonstrating that they did not benefit from the addition of adjuvant chemotherapy. However, by analyzing 2,318 patients with ILC, Nonneville et al (42) reported that ILC patients exhibited significant differences in DFS or OS benefit from chemotherapy in high-risk patients, such as those who were lymph node positive or presented with lympho-vascular invasion. In agreement with previous results, we identified negative HR, N2/N3, stage III, and receiving radiotherapy as predictors for long-term adverse outcomes in ILC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Overall Survival Between Invasive Lobular Breast Carcinoma and Invasive Ductal Breast Carcinoma: A Propensity Score Matching Study Based on SEER Database

et al. 2020

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ObjectiveInvasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) account for most breast cancers. However, the overall survival (OS) differences between ILC and IDC remain controversial. This study aimed to compare nonmetastatic ILC to IDC in terms of survival and prognostic factors for ILC.MethodsThis retrospective cohort study used data from the Surveillance, Epidemiology and End Results (SEER) Cancer Database (www.seer.cancer.gov). Women diagnosed with nonmetastatic ILC and IDC between 2006 and 2016 were included. A propensity score matching (PSM) method was used in our analysis to reduce baseline differences in clinicopathological characteristics and survival outcomes. Kaplan-Meier curves and log-rank test were used for survival analysis.ResultsCompared to IDC patients, ILC patients were diagnosed later in life with poorly differentiated and larger lesions, as well as increased expression of estrogen receptors (ERs) and/or progesterone receptors (PRs). A lower rate of radiation therapy and chemotherapy was observed in ILC. After PSM, ILC, and IDC patients exhibited similar OS (HR=1.017, p=0.409, 95% CI: 0.967–1.069). In subgroup analysis of HR-negative, AJCC stage III, N2/N3 stage patients, or those who received radiotherapy, ILC patients exhibited worse OS compared to IDC patients. Furthermore, multivariate analysis revealed a 47% survival benefit for IDC compared to ILC in HR-negative patients who received chemotherapy (HR=1.47, p=0.01, 95% CI: 1.09–1.97).ConclusionsOur results demonstrated that ILC and IDC patients had similar OS after PSM. However, ILC patients with high risk indicators had worse OS compared to IDC patients by subgroup analysis.

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“…In 2017, identifying 4638 ILC from California Cancer Registry (CCR), Marmor et al [13] determined a similar result that patients with estrogen receptor (ER)positive, HER2-negative, stage I/II ILC who received adjuvant endocrine therapy did not benefit from the addition of adjuvant chemotherapy. However, using 2318 ILC data source from 15 academic French cancer centers between 1990 and 2014, Nonneville et al [14] recently reported that the significant disease-free survival (DFS) and OS benefits from adjuvant chemotherapy could be derived in high-risk ILC patients, but not in low-risk ILC patients.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0–1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database

Hu²,

Zhang

et al. 2020

BMC Cancer

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Background The benefit of adjuvant chemotherapy in invasive lobular carcinoma (ILC) is still unclear. The objective of the current study was to elucidate the effectiveness of adjuvant chemotherapy in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1b-c/N0–1/M0 ILC. Methods Based on Surveillance, Epidemiology, and End-Results (SEER) database, we identified original 12,334 HR-positive, HER2-negative, pT1b-c/N0–1/M0 ILC patients, who were then divided into adjuvant chemotherapy group and control group. End-points were overall survival (OS) and breast cancer-specific mortality (BCSM). Aiming to minimize the selection bias of baseline characteristics, Propensity Score Matching (PSM) method was used. Results In a total of 12,334 patients with HR-positive, HER2-negative, pT1b-c/N0–1/M0 ILC, 1785 patients (14.5%) were allocated into adjuvant chemotherapy group and 10,549 (85.5%) into control group. Used PSM, the 1785 patients in adjuvant chemotherapy group matched to the 1785 patients in control group. By Kaplan-Meier survival analyses, we observed no beneficial effect of adjuvant chemotherapy on OS in both original samples (P = 0.639) and matched samples (P = 0.962), however, ineffective or even contrary results of adjuvant chemotherapy on BCSM both in original samples (P = 0.001) and in matched samples (P = 0.002). In both original and matched multivariate Cox models, we observed ineffectiveness of adjuvant chemotherapy on OS (hazard ratio (HR) for overall survival = 0.82, 95% confidence interval (CI) [0.62–1.09]; P = 0.172 and HR = 0.90, 95%CI [0.65–1.26]; P = 0.553, respectively), unexpectedly promoting effect of adjuvant chemotherapy on BCSM (HR = 2.33, 95%CI [1.47–3.67]; P = 0.001 and HR = 2.41, 95%CI [1.32–4.39]; P = 0.004, respectively). Standard surgery was beneficial to the survival of patients. Lymph node metastasis was detrimental to survival and radiotherapy brought survival benefit in original samples, but two issues had unobvious effect in matched samples. Conclusion In this study, adjuvant chemotherapy did not improve survival for patients with HR-positive, HER2-negative pT1b-c/N0–1/M0 ILC.

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Adjuvant chemotherapy in lobular carcinoma of the breast: a clinicopathological score identifies high-risk patient with survival benefit

Cited by 22 publications

References 29 publications

The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecular subtypes of the breast

The prognosis of invasive ductal carcinoma, lobular carcinoma and mixed ductal and lobular carcinoma according to molecular subtypes of the breast

Comparison of Overall Survival Between Invasive Lobular Breast Carcinoma and Invasive Ductal Breast Carcinoma: A Propensity Score Matching Study Based on SEER Database

Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0–1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database

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