Mathew Aju, Rajagopal Padma S, Villgran Vipin, Sandhu Gurprataap S, Jankowitz Rachel C, Jacob Mini, Rosenzweig Margaret, Oesterreich Steffi, Brufsky Adam
University of Kentucky Markey Cancer Center, Lexington, KY, USA.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Geburtshilfe Frauenheilkd. 2017 Jun;77(6):660-666. doi: 10.1055/s-0043-109374. Epub 2017 Jun 28.
Invasive lobular carcinoma (ILC) comprises around 10 - 15% of invasive breast cancers. Few prior studies have demonstrated a unique pattern of metastases between ILC and the more common invasive ductal carcinoma (IDC). To our knowledge, such data is limited to first sites of distant recurrence. We aimed to perform a comparison of the metastatic pattern of ILC and IDC at first distant recurrence as well as over the entire course of metastatic disease.
We used a prospectively collated database of patients with metastatic breast cancer. Breast cancer recurrence or metastases were classified into various sites and a descriptive analysis was performed.
Among 761 patients, 88 (11.6%) were diagnosed with ILC and 673 (88.4%) with IDC. Patients with ILC showed more frequent metastases to the bone (56.8 vs. 37.7%, p = 0.001) and gastrointestinal (GI) tract (5.7 vs. 0.3%, p < 0.001) as first site of distant recurrence, and less to organs such as lung (5.7 vs. 24.2%, p < 0.001) and liver (4.6 vs. 11.4%, p = 0.049). Over the entire course of metastatic disease, more patients with ILC had ovarian (5.7 vs. 2.1%, p = 0.042) and GI tract metastases (8.0 vs. 0.6%, p < 0.001), also demonstrating reduced tendency to metastasize to the liver (20.5 vs. 49.0%, p < 0.001) and lung (23.9 vs. 51.9%, p < 0.001). All associations but bone held after sensitivity analysis on hormonal status. Although patients presenting with ILC were noted to have more advanced stage at presentation, recurrence-free survival in these patients was increased (4.8 years vs. 3.2 years, p = 0.017). However, overall survival was not (2.5 vs. 2.0 years, p = 0.75).
After accounting for hormone receptor status, patients with IDC had greater lung/pleura and liver involvement, while patients with ILC had a greater propensity to develop ovarian and GI metastases both at first site and overall. Clinicians can use this information to provide more directed screening for metastases; it also adds to the argument that these two variants of breast cancer should be managed as unique diseases.
浸润性小叶癌（ILC）约占浸润性乳腺癌的10%-15%。既往很少有研究表明ILC与更常见的浸润性导管癌（IDC）之间存在独特的转移模式。据我们所知，此类数据仅限于远处复发的首发部位。我们旨在比较ILC和IDC在首次远处复发时以及在转移性疾病的整个病程中的转移模式。
我们使用了一个前瞻性整理的转移性乳腺癌患者数据库。将乳腺癌复发或转移分类到不同部位并进行描述性分析。
在761例患者中，88例（11.6%）被诊断为ILC，673例（88.4%）为IDC。ILC患者作为远处复发的首发部位，骨转移（56.8%对37.7%，p = 0.001）和胃肠道（GI）转移（5.7%对0.3%，p < 0.001）更常见，而肺（5.7%对24.2%，p < 0.001）和肝（4.6%对11.4%，p = 0.049）等器官转移较少。在转移性疾病的整个病程中，更多ILC患者发生卵巢转移（5.7%对2.1%，p = 0.042）和胃肠道转移（8.0%对0.6%，p < 0.001），同时转移至肝（20.5%对49.0%，p < 0.001）和肺（23.9%对51.9%，p < 0.001）的倾向也降低。在对激素状态进行敏感性分析后，除骨转移外的所有关联均成立。尽管发现表现为ILC的患者在初诊时分期更晚，但这些患者的无复发生存期延长（4.8年对3.2年，p = 0.017）。然而，总生存期并无差异（2.5年对2.0年，p = 0.75）。
在考虑激素受体状态后，IDC患者肺/胸膜和肝受累更多，而ILC患者在首发部位及总体上发生卵巢和胃肠道转移的倾向更大。临床医生可利用这些信息进行更有针对性的转移筛查；这也进一步支持了这两种乳腺癌变体应作为独特疾病进行管理的观点。
