Raghavendra Akshara S, Bassett Roland, Damodaran Senthil, Barcenas Carlos H, Mouabbi Jason A, Layman Rachel, Tripathy Debu
Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Netw Open. 2025 Apr 1;8(4):e251888. doi: 10.1001/jamanetworkopen.2025.1888.
Comparing the clinical and molecular features of metastatic invasive lobular carcinoma (mILC) and metastatic invasive ductal carcinoma (mIDC) is essential to enhance understanding of breast cancer biology and improve personalized treatment approaches.
To compare mILC and mIDC in terms of survival outcomes and to investigate the association of clinicopathologic characteristics with those outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adult patients at the University of Texas MD Anderson Cancer Center with their first metastatic diagnosis occurring between January 1997 and December 2020. Patient records were obtained from an institutional database. The study follow-up concluded in July 2023, and data were analyzed from July to December 2024.
Diagnosis of mIDC and mILC.
Progression-free survival (PFS), overall survival (OS), and disease-free interval (DFI) were estimated using the Kaplan-Meier method. Survival distributions were compared using the log-rank test. Multivariable Cox proportional hazards regression was used to assess the association of metastasis onset, estrogen receptor (ER) expression level, and tumor grade with OS and PFS.
The analysis included a total of 9714 patients (9628 women [99%]), 8535 with mIDC and 1179 with mILC. The median age at metastasis was 53.3 years (range, 17.6-62.0 years). Generally, patients with mILC were older and had lower nuclear grade tumors and fewer metastasis sites than patients with mIDC. Patients with mILC had longer PFS (median, 0.65 years; 95% CI, 0.58-0.74) than patients with mIDC (median, 0.46 years; 95% CI, 0.45-0.48) (hazard ratio [HR], 0.78; 95% CI, 0.73-0.84; P < .001). For OS, patients with mILC had longer OS (median, 3.06 years; 95% CI, 2.87-3.29) than patients with mIDC (median, 2.60 years; 95% CI, 2.52-2.67 years) (HR, 0.91; 95% CI, 0.84-0.98; P = .01). Overall, patients with mILC had longer DFI than patients with mIDC (HR, 0.69; 95% CI, 0.64-0.75; P < .001). At initial diagnosis, patients with mILC were less likely to present with visceral metastasis (522 patients [44.3%]) than patients with mIDC (4909 patients [57.5%]). A higher proportion of patients with mILC (931 patients [79.0%]) than patients with mIDC (5431 patients [63.6%]) had bone-only metastasis.
In this cohort study, patients with mILC had longer OS and PFS than those with mIDC. Metastasis onset, ER positivity, and tumor grade were associated with survival outcomes, and distinct metastatic patterns of mIDC and mILC were also associated with survival for mIDC and mILC, which may help guide more personalized treatment strategies for each subtype.
比较转移性浸润性小叶癌（mILC）和转移性浸润性导管癌（mIDC）的临床和分子特征对于增强对乳腺癌生物学的理解以及改进个性化治疗方法至关重要。
比较mILC和mIDC的生存结局，并研究临床病理特征与这些结局之间的关联。
设计、地点和参与者：这项队列研究纳入了得克萨斯大学MD安德森癌症中心的成年患者，他们于1997年1月至2020年12月期间首次被诊断为转移性疾病。患者记录来自机构数据库。研究随访于2023年7月结束，数据于2024年7月至12月进行分析。
mIDC和mILC的诊断。
采用Kaplan-Meier方法估计无进展生存期（PFS）、总生存期（OS）和无病间期（DFI）。使用对数秩检验比较生存分布。多变量Cox比例风险回归用于评估转移发生、雌激素受体（ER）表达水平和肿瘤分级与OS和PFS之间的关联。
分析共纳入9714例患者（9628例女性[99%]），其中8535例为mIDC，1179例为mILC。转移时的中位年龄为53.3岁（范围17.6 - 62.0岁）。总体而言，与mIDC患者相比，mILC患者年龄更大，肿瘤核分级更低，转移部位更少。mILC患者的PFS长于mIDC患者（中位值0.65年；95%置信区间，0.58 - 0.74）（风险比[HR]，0.78；95%置信区间，0.73 - 0.84；P <.001）。对于OS，mILC患者的OS长于mIDC患者（中位值3.06年；95%置信区间，2.87 - 3.29）（中位值2.60年；95%置信区间，2.52 - 2.67年）（HR，0.91；95%置信区间，0.84 - 0.98；P = 0.01）。总体而言，mILC患者的DFI长于mIDC患者（HR，0.69；95%置信区间，0.64 - 0.75；P <.001）。在初始诊断时，mILC患者出现内脏转移的可能性低于mIDC患者（522例患者[44.3%]）（4909例患者[57.5%]）。mILC患者中仅发生骨转移的比例高于mIDC患者（931例患者[79.0%]）（5431例患者[63.6%]）。
在这项队列研究中，mILC患者的OS和PFS长于mIDC患者。转移发生、ER阳性和肿瘤分级与生存结局相关，mIDC和mILC不同的转移模式也与mIDC和mILC的生存相关，这可能有助于为每种亚型制定更个性化的治疗策略。
