Mixed invasive ductal and lobular carcinoma has distinct clinical features and predicts worse prognosis when stratified by estrogen receptor status

Xiao, Yi; Ma, Ding; Ruan, Miao; Liu, Xi Yu; Jiang, Yi; Shao, Zhi Ming

doi:10.1038/s41598-017-10789-x

Cited by 23 publications

(20 citation statements)

References 29 publications

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“…In this study, the overall results suggested similar survival outcomes between patients with ILC and IDC-L, but when stratifying by menopausal status, we noticed superior survival outcomes for patients with IDC-L. These observations were corroborated by a large analysis of the Surveillance, Epidemiology, and End Results (SEER) database, including a total of 209,109 patients [22]. In the SEER analysis, Xiao et al compared survival outcomes based on histology, including 172,379 patients with IDC, 17,503 patients with ILC, and 19,227 patients with IDC-L.…”

Section: Discussionsupporting

confidence: 78%

“…By contrast, the HR for the comparison of IDC‐L versus ILC decreased over time, indicating better long‐term prognosis for IDC‐L versus ILC. When evaluating the differences in outcomes between IDC‐L and ILC, patients aged >50 years diagnosed with IDC‐L had superior outcomes . Although the larger sample size from the SEER analysis provided robust prognostic information, the lack of detailed clinicopathologic information (e.g.…”

Section: Discussionmentioning

confidence: 99%

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Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

et al. 2018

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Background The diagnosis of mixed invasive ductal and lobular carcinoma (IDC‐L) in clinical practice is often associated with uncertainty related to its prognosis and response to systemic therapies. With the increasing recognition of invasive lobular carcinoma (ILC) as a distinct disease subtype, questions surrounding IDC‐L become even more relevant. In this study, we took advantage of a detailed clinical database to compare IDC‐L and ILC regarding clinicopathologic and treatment characteristics, prognostic power of histologic grade, and survival outcomes. Materials and Methods In this retrospective cohort study, we identified 811 patients diagnosed with early‐stage breast cancer with IDC‐L or ILC. Descriptive statistics were performed to compare baseline clinicopathologic characteristics and treatments. Survival rates were subsequently analyzed using the Kaplan–Meier method and compared using the Cox proportional hazards model. Results Patients with ILC had more commonly multifocal disease, low to intermediate histologic grade, and HER2‐negative disease. Histologic grade was prognostic for patients with IDC‐L but had no significant discriminatory power in patients with ILC. Among postmenopausal women, those with IDC‐L had significantly better outcomes when compared with those with ILC: disease‐free survival (DFS) and overall survival (OS; adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.31–0.95). Finally, postmenopausal women treated with an aromatase inhibitor had more favorable DFS and OS than those treated with tamoxifen only (OS adjusted HR, 0.50; 95% CI, 0.29–0.87), which was similar for both histologic types (p = .212). Conclusion IDC‐L tumors have a better prognosis than ILC tumors, particularly among postmenopausal women. Histologic grade is an important prognostic factor in IDC‐L but not in ILC. Implications for Practice This study compared mixed invasive ductal and lobular carcinoma (IDC‐L) with invasive lobular carcinomas (ILCs) to assess the overall prognosis, the prognostic role of histologic grade, and response to systemic therapy. It was found that patients with IDC‐L tumors have a better prognosis than ILC, particularly among postmenopausal women, which may impact follow‐up strategies. Moreover, although histologic grade failed to stratify the risk of ILC, it showed an important prognostic power in IDC‐L, thus highlighting its clinical utility to guide treatment decisions of IDC‐L. Finally, the disease‐free survival advantage of adjuvant aromatase inhibitors over tamoxifen in ILC was consistent in IDC‐L.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

et al. 2018

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“…Other studies found that patients with IDC had better disease-free survival and marginally better BCSS relative to those with IDLC [11]. In addition, IDLC may predict poorer prognosis than IDC in both ER(+) and ER(−) subgroup [15], in which the status of HER2 was absent. We found that IDLC showed better OS but not BCSS compared with IDC in the multivariate model, which was consistent with the results of survival curves after matching.…”

Section: Discussionmentioning

confidence: 96%

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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“…2 ILC tends to be more bilateral, multifocal, larger tumors, high ER and PR expression and lower HER expression compared to IDC. 6 There has been an intermediate classification with both of these types referred to as IDC-L. WHO categorizes it as "having an ILC pattern in at least 50% of the tumor and an IDC pattern in between 10% and 49%". 6 Breast Cancer specific survival curve indicates that those with IDC-L fare better than the IDC or ILC group.…”

Section: Introductionmentioning

confidence: 99%

Three-in-one: case of multiple primary malignancies concurrently in a 70 year-old female

Malhis¹,

Shah²,

O’Brien³

et al. 2021

JCPCR

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Multiple primary malignancies (MPM) are an increasing trend seen in oncology due to factors of increased survival time of patients, environmental exposures and hereditary risk factors. The increase of diagnoses is also seen with more screenings as well as longer life expectancies. We present a 70 year old female who initially presented with trouble swallowing. It was revealed she had squamous cell carcinoma (SCC) of her epiglottis. PET scan work up revealed uptake in her left breast. Bilateral mammogram, ultrasound and biopsy revealed her left breast had invasive ductal carcinoma (IDC) and her right had invasive lobular carcinoma (ILC). With her smoking history and strong family history of cancer, she was highly susceptible to developing multiple primary malignancies She did not continue routine health screenings including mammogram and low dose CT chest which may have prevented or discovered her malignancies at an early stage. This is an emphasis on the importance of routine health surveillance and screening especially in the primary care setting.

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Mixed invasive ductal and lobular carcinoma has distinct clinical features and predicts worse prognosis when stratified by estrogen receptor status

Cited by 23 publications

References 29 publications

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

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

Three-in-one: case of multiple primary malignancies concurrently in a 70 year-old female

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