Abstract
BackgroundInvasive lobular carcinomas (ILCs) account for 10–15% of all breast cancers. They are characterized by an elevated endocrine responsiveness and by a long lasting risk of relapse over time. Here we report for the first time an analysis of clinical and pathological features associated with the risk of late distant recurrence in ILCs.Patients and methodsWe retrospectively analyzed all consecutive patients with hormone receptor–positive ILC operated at the European Institute of Oncology (EIO) between June 1994 and December 2010 and scheduled to receive at least 5 years of endocrine treatment.The aim was to identify clinical and pathological variables that provide prognostic information in the period beginning 5 years after definitive surgery. The cumulative incidence of distant metastases (CI-DM) from 5 years after surgery was the prospectively defined primary endpoint.ResultsOne thousand eight hundred seventy-two patients fulfilled the inclusion criteria. The median follow-up was 8.7 years.Increased tumor size and positive nodal status were significantly associated with higher risk of late distant recurrence, but nodal status had a significant lower prognostic value in late follow-up period (DM-HR, 3.21; 95% CI, 2.06–5.01) as compared with the first 5 years of follow-up (DM-HR, 9.55; 95% CI, 5.64–16.2; heterogeneity p value 0.002).Elevated Ki-67 labeling index (LI) retained a significant and independent prognostic value even after the first 5 years from surgery (DM-HR, 1.81; 95% CI 1.19–2.75), and it also stratified the prognosis of ILC patients subgrouped according to lymph node status.A combined score, obtained integrating the previously validated Clinical Treatment Score post 5 years (CTS5) and Ki-67 LI, had a strong association with the risk of late distant recurrence of ILCs.ConclusionWe identified factors associated with the risk of late distant recurrence in ER-positive ILCs and developed a simple prognostic score, based on data that are readily available, which warrants further validation.
Highlights
Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer (BC) and accounts for approximately 10–15% of all BCs
Elevated Ki-67 labeling index (LI) retained a significant and independent prognostic value even after the first 5 years from surgery (DM-HR, 1.81; 95% CI 1.19–2.75), and it stratified the prognosis of ILC patients subgrouped according to lymph node status
We identified factors associated with the risk of late distant recurrence in ER-positive ILCs and developed a simple prognostic score, based on data that are readily available, which warrants further validation
Summary
Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer (BC) and accounts for approximately 10–15% of all BCs. In gene expression profiling studies, more than 80% of ILCs are classified as luminal A, with very few cases classified as HER2-enriched or basal-like molecular subtypes [2]. These biological features translate in an elevated endocrine responsiveness and in a peculiar pattern of risk of relapse, characterized by a very long lasting risk over time [3, 4]. Invasive lobular carcinomas (ILCs) account for 10–15% of all breast cancers. They are characterized by an elevated endocrine responsiveness and by a long lasting risk of relapse over time.
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