John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Ann Surg Oncol. 2010 Jul;17(7):1862-9. doi: 10.1245/s10434-010-0953-z. Epub 2010 Feb 17.
Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC.
Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis.
When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6%; P < 0.001), lymph node positive (36.8 vs. 34.4%; P < 0.001), and ER positive (93.1 vs. 75.6%; P < 0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88%; P < 0.001) and after matching for stage T1N0 (98 vs. 96%; P < 0.001), T2N0 (94 vs. 88%; P < 0.001), and T3N0 (92 vs. 83%, P < 0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89% vs. 88% (P = NS) for stage T1N1, 81 vs. 73% (P < 0.001) for T2N1, and 72 vs. 56% (P < 0.001) for T3N1. Multivariate analysis identified a 14% survival benefit for ILC (hazard ratio 0.86, 95% confidence interval 0.80-0.92).
Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.
浸润性小叶乳腺癌（ILC）比浸润性导管乳腺癌（IDC）少见，在乳房 X 光片中更难检测到，并且通常在较晚的阶段诊断出来。ILC 的延迟诊断是否会影响生存率？我们使用国家登记处比较了分期匹配的 ILC 和 IDC 患者的结局。
通过国家癌症研究所的监测、流行病学和最终结果（SEER）肿瘤登记处查询，确定了 1993 年至 2003 年期间诊断为 IDC 或 ILC 的 263408 名女性。使用 Kaplan-Meier 曲线和对数秩分析比较 T 期和 N 期匹配的患者的生存情况。
与 IDC 相比，ILC 更有可能大于 2cm（43.1%比 32.6%；P<0.001）、淋巴结阳性（36.8%比 34.4%；P<0.001）和 ER 阳性（93.1%比 75.6%；P<0.001）。ILC 患者的 5 年疾病特异性生存率（DSS）明显优于 IDC 患者，未经分期匹配时（90%比 88%；P<0.001）和 T1N0 分期匹配时（98%比 96%；P<0.001）、T2N0（94%比 88%；P<0.001）和 T3N0（92%比 83%，P<0.001）。ILC 患者淋巴结转移的 5 年 DSS 为 T1N1 期 89%比 IDC 88%（P=NS），T2N1 期 81%比 IDC 73%（P<0.001），T3N1 期 72%比 IDC 56%（P<0.001）。多变量分析确定 ILC 的生存率提高了 14%（风险比 0.86，95%置信区间 0.80-0.92）。
分期匹配的预后对 ILC 患者比 IDC 患者更好。我们的研究结果支持 ILC 具有不同的生物学特性，这对咨询和风险分层很重要。
