Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Eur J Cancer. 2023 Sep;191:113250. doi: 10.1016/j.ejca.2023.113250. Epub 2023 Jul 22.
To determine if the outcomes of patients with ILC co-occurring with LCIS are similar to pure ILC and if the presence of LCIS is a prognostic factor for ILC.
In an observational, population-based investigation using data from the MD Anderson breast cancer prospectively collected electronic database, we analysed patients with a diagnosis of stage I-III ILC. Patients were divided into two groups: those with ILC with co-occurring ipsilateral LCIS (ILC + LCIS) and those with pure ILC without a histologically detected co-occurring ipsilateral LCIS (ILC alone). We obtained data on demographics, pathologic tumour size (pT), pathologic lymph node (pN) involvement, estrogen (ER), progesterone (PR) receptor status, HER2 status, Ki67, treatment received, distant recurrence-free and overall survival (DRFS, OS).
We identified 4217 patients with stage I-III ILC treated at MD Anderson between 1966 and 2021. 45% of cases (n = 1881) had co-existing LCIS. Statistically and numerically, ILC alone tended to associate with pT4 and pN3 stage (P < 0.001), ER/PR negativity (P = 0.0002), HER2 positivity (P = 0.010), higher Ki67 (P = 0.005), non-classical ILC subtype (P = 0.04) and more exposure to neoadjuvant chemotherapy (P = 0.0002) compared to the ILC + LCIS group. The median follow-up time was 6.5 years. Patients with ILC + LCIS had better median DRFS (16.8 versus 10.1 years, Hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.50-0.60, P < 0.0001) and better median OS (18.9 versus 13.7 years, HR 0.62, 95% CI 0.56-0.69; P < 0.0001). Multivariate analysis showed the absence of LCIS to be an independent poor prognostic factor along with a higher pT stage and higher pN stage for DRFS and OS.
The findings of this study suggests that the absence of ipsilateral LCIS with ILC is an independent poor prognostic factor and that further studies are warranted to understand this phenomenon.
确定同时患有浸润性小叶癌（ILC）和导管原位癌（LCIS）的患者的结局是否与单纯 ILC 相似，以及 LCIS 的存在是否为 ILC 的预后因素。
在一项使用 MD Anderson 前瞻性收集的电子数据库中数据进行的观察性、基于人群的研究中，我们分析了诊断为 I 期-III 期 ILC 的患者。患者分为两组：同时患有同侧 LCIS（ILC+LCIS）的患者和单纯患有 ILC 而无组织学检测到同侧 LCIS（单纯 ILC）的患者。我们获得了患者的人口统计学、肿瘤病理大小（pT）、病理淋巴结（pN）受累、雌激素（ER）、孕激素（PR）受体状态、HER2 状态、Ki67、接受的治疗、远处无复发生存（DRFS）和总生存（OS）等数据。
我们在 1966 年至 2021 年间在 MD Anderson 治疗的 4217 名 I 期-III 期 ILC 患者中识别出 45%（n=1881）存在同时患有 LCIS。统计学上和数值上，单纯 ILC 往往与 pT4 和 pN3 期（P<0.001）、ER/PR 阴性（P=0.0002）、HER2 阳性（P=0.010）、Ki67 较高（P=0.005）、非典型 ILC 亚型（P=0.04）和更多接受新辅助化疗（P=0.0002）相关。中位随访时间为 6.5 年。ILC+LCIS 组的患者 DRFS 中位值更好（16.8 年比 10.1 年，风险比[HR]0.55，95%置信区间[CI]0.50-0.60，P<0.0001）和 OS 中位值更好（18.9 年比 13.7 年，HR 0.62，95% CI 0.56-0.69；P<0.0001）。多变量分析显示，无同侧 LCIS 与较高的 pT 期和 pN 期一样，是 DRFS 和 OS 的独立不良预后因素。
这项研究的结果表明，ILC 中同侧 LCIS 的缺失是独立的不良预后因素，需要进一步研究以了解这一现象。
