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. 2017 Sep 1;12(9):e0182397.
doi: 10.1371/journal.pone.0182397. eCollection 2017.

Invasive lobular carcinoma of the breast: A special histological type compared with invasive ductal carcinoma

Zheling Chen  1 , Jiao Yang  1 , Shuting Li  1 , Meng Lv  1 , Yanwei Shen  1 , Biyuan Wang  1 , Pan Li  1 , Min Yi  1   2 , Xiao'ai Zhao  1 , Lingxiao Zhang  1 , Le Wang  1 , Jin Yang  1
Affiliations

Invasive lobular carcinoma of the breast: A special histological type compared with invasive ductal carcinoma

Zheling Chen et al. PLoS One. .

Abstract

The clinical outcomes and therapeutic strategies for infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) are not uniform. The primary objectives of this study were to identify the differences in the clinical characteristics and prognoses between ILC and IDC, and identify the high-risk population based on the hormone receptor status and metastasis sites. The Surveillance, Epidemiology, and End Results Program database was searched and patients diagnosed with ILC or IDC from 1990 to 2013 were identified. In total,796,335 patients were analyzed, including 85,048 withILC (10.7%) and 711,287 withIDC (89.3%). The ILC group was correlatedwith older age, larger tumor size, later stage, lower grade, metastasis disease(M1) disease, and greater counts ofpositive lymph nodesandestrogen-receptor-positive (ER)/progesterone receptor-positive (PR) positive nodes. The overall survival showed an early advantage for ILC but a worse outcome after 5 years. Regarding the disease-specific survival, the IDC cohort had advantages over the ILC group, both during the early years and long-term. In hormone status and metastasis site subgroup analyses, the ER+/PR+ subgroup had the best survival, while the ER+/PR- subgroup had the worst outcome, especially the ILC cohort. ILC and IDC had different metastasis patterns. The proportion of bone metastasis was higher in the ILC group (91.52%) than that in the IDC (76.04%), and the ILC group was more likely to have multiple metastasis sites. Survival analyses showed patients with ILC had a higher risk of liver metastasis (disease-specific survival[DSS]; P = 0.046), but had a better overall survival than the bone metastasis group (P<0.0001). We concluded that the long-term prognosis for ILC was poorer than that for IDC, and the ER+/PR- subgroup had the worst outcome. Therefore, the metastasis pattern and prognosis must be seriously evaluated, and a combination of endocrine therapy and chemotherapy should be considered.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram for patient selection.
The Surveillance Epidemiology and End Results (SEER) 1990–2013 database was used to identify patients diagnosed with breast carcinoma. Patients were excluded if their disease was not malignant or the age was unknown. And other histology types of disease, including mixed disease were excluded. As the result, the patients were divided into two groups, infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC).
Fig 2
Fig 2. Comparison of overall survival (OS) rates and disease-specific survival (DSS) rates of infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC).
Fig 3
Fig 3. Comparison of overall survival (OS) rates and disease-specific survival (DSS) ratesof infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) based on hormone receptor status.
Fig 4
Fig 4. Kaplan–Meier survival curves of infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) based on hormone receptor statusmatched by stage.
OS, overall survival; DSS, Disease-specific survival.
Fig 5
Fig 5. Comparison of overall survival (OS) rates and disease-specific survival (DSS) rates of infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) stratified by different metasasis sites.
See this image and copyright information in PMC

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