Abstract
The outcome and prognostic factors of 217 women with invasive lobular carcinoma (ILC) and those of 1121 women with invasive ductal carcinoma (IDC) of the breast were compared. The patients were followed up for 10-43 years. Women with ILC had axillary nodal metastases less frequently than those with IDC (43% vs 53%, P = 0.02), although there was no difference in the primary tumour size between the groups. ILCs were more frequently of low grade, had lower mitotic counts and had less tumour necrosis. Furthermore, ILCs had lower S-phase fractions and were more often DNA diploid in flow cytometric analysis than IDCs (P < 0.0001 for all comparisons). The 5- and 30-year corrected survival rates of women with ILC were 78% and 50%, respectively, compared with 63% and 37% for women with IDC (P = 0.001). Small pT1NOMO ILCs (n = 41) had 100% 10-year and 83% 20-year corrected survival rates. In a multivariate analysis, a large primary tumour size, the presence of axillary nodal metastases, a high mitotic count and the presence of tumour necrosis all had an independent prognostic value in ILC. We conclude that ILC is associated with better survival than IDC.
Highlights
In previous analyses using the same data, we have compared the corrected survival rate obtained by identifying the intercurrent deaths based on clinical evidence and the relative survival obtained by dividing the overall survival of the cohort by the expected survival in the age- and sex-matched general population; we found both methods to result in an almost identical survival curve, suggesting that there is no major misclassification of breast cancer deaths as intercurrent deaths in the series (Joensuu and Toikkanen, 1995)
invasive lobular carcinoma (ILC) more rarely had axillary nodal metastases than invasive ductal carcinoma (IDC) (P = 0.02), there was no significant difference in the primary tumour size between the groups (P = 0.19)
There was no significant difference in the frequency for the known presence of cancer in first-degree female relatives (7% vs 8%, P = 0.63), for the presence of inflammatory carcinoma (1% vs 2%, P = 0.65) or for skin ulceration at presentation (4% vs 1%, P = 0.08) a significantly higher proportion of women with ILC (11%, n = 26) developed cancer in the contralateral breast during follow-up compared with those with IDC (6%, n = 71) (P = 0.006)
Summary
In order to identify all patients diagnosed with invasive breast cancer in the city of Turku, located in South-Western Finland, the hospital records of the two hospitals treating breast cancer in the area, the Turku University Central Hospital and the City Hospital of Turku, were examined. Based on the data obtained from the Finnish Cancer Registry and other data, we estimate that this is 94% of all cases diagnosed with breast cancer in the city during the time period. The cumulative survival was estimated with the product-limit method, and comparison of the cumulative survival rate between groups was performed using the log-rank and generalized Wilcoxon tests. Both overall (crude) survival rates and survival rates corrected for intercurrent deaths were calculated.
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