Han Boyue, Gu Zhangyuan, Liu Zhebin, Ling Hong
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, People's Republic of China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Cancer Manag Res. 2022 Feb 16;14:647-658. doi: 10.2147/CMAR.S346319. eCollection 2022.
The objective of this study was to compare the demographic characteristics, clinicopathological factors and survival outcomes between infiltrating lobular carcinoma (ILC) and infiltrating ductal carcinoma (IDC) using our single-center database.
Seventeen thousand two hundred and three breast cancer patients were treated at Fudan University Shanghai Cancer Center (FUSCC) from January 2000 to December 2017. We identified 365 cases with ILC and 16,838 cases with IDC. The Pearson chi-square test was used to compare tumor characteristics, and the Kaplan-Meier methods were used to perform the survival analysis.
ILC had some distinctive characteristics from IDC such as older age (ranged from 61 to 80: ILC 26.8% vs IDC 19.9%, P < 0.001; over 80: ILC 1.6% vs IDC 0.8%, P < 0.001), larger tumor size (ranged from 2 to 5: ILC 45.2% vs IDC 37.1%, P = 0.011), much more hormone receptor expression (ILC 92.9% vs IDC 73.0%, P < 0.001), extremely less HER-2 expression (ILC 7.1% vs IDC 25.9%, P < 0.001). The overall survival and disease-free survival of ILC were worse than IDC (5-year OS, ILC 93.6% vs IDC 94.5%, P < 0.001; 5-year DFS, ILC 88.5% vs IDC 91.6%, P = 0.008). It was worth noting that the ILC patients had a worse overall survival than IDC patients after our propensity score matching study (P = 0.037). The univariate analysis concluded that positive HR (hormone receptor), high expression of Ki-67 and higher pathologic tumor stage were poor prognostic markers of ILC. Multivariate analysis demonstrated that tumor stage was a poor prognostic marker after adjustment for the effects of the above three factors. The most common primary site of metastasis was bone, but the proportion in the ILC group was much higher than that in the IDC group (56.25% vs 36.40%, P = 0.003).
Compared with IDC, ILC survived worse and was more prone to bone metastasis. Therefore, a comprehensive understanding of ILC and specific treatments are needed for further research.
本研究旨在利用我们的单中心数据库比较浸润性小叶癌（ILC）和浸润性导管癌（IDC）之间的人口统计学特征、临床病理因素和生存结果。
2000年1月至2017年12月期间，复旦大学附属肿瘤医院共治疗了17203例乳腺癌患者。我们识别出365例ILC患者和16838例IDC患者。采用Pearson卡方检验比较肿瘤特征，并使用Kaplan-Meier方法进行生存分析。
ILC与IDC有一些不同的特征，如年龄较大（61至80岁：ILC为26.8%，IDC为19.9%，P<0.001；80岁以上：ILC为1.6%，IDC为0.8%，P<0.001）、肿瘤尺寸较大（2至5厘米：ILC为45.2%，IDC为37.1%，P=0.011）、激素受体表达更多（ILC为92.9%，IDC为73.0%，P<0.001）、HER-2表达极少（ILC为7.1%，IDC为25.9%，P<0.001）。ILC的总生存期和无病生存期均比IDC差（5年总生存期，ILC为93.6%，IDC为94.5%，P<0.001；5年无病生存期，ILC为88.5%，IDC为91.6%，P=0.008）。值得注意的是，在我们的倾向评分匹配研究后，ILC患者的总生存期比IDC患者差（P=0.037）。单因素分析得出，激素受体（HR）阳性、Ki-67高表达和更高的病理肿瘤分期是ILC预后不良的标志物。多因素分析表明，在调整上述三个因素的影响后，肿瘤分期是一个预后不良的标志物。最常见的转移原发部位是骨，但ILC组中的比例远高于IDC组（56.25%对36.40%，P=0.003）。
与IDC相比，ILC的生存期更差，且更易发生骨转移。因此，需要对ILC进行全面了解并开展进一步研究的特异性治疗。
