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Invasive Pleomorphic Lobular Histology Is an Adverse Prognostic Factor on Survival in Patients with Breast Cancer.

Abstract Invasive pleomorphic lobular carcinoma (IPLC) is defined to be an uncommon and different subtype of classical invasive lobular carcinoma (ILC). This special variant is characterized by significant cytological atypia and pleomorphism which differs from the cytological uniformity of ILC. IPLC has been shown to have some poor prognostic factors such as axillary node metastasis and higher histological grade which may lead to poor clinical courses including a short relapse time, increased risk of recurrence and a decreased survival. The aim of this study is to investigate the clinicopathological characteristics and prognosis of IPLC in comparison with ILC and also to evaluate if IPLC is a different clinical entity compared to ILC. A total number of 4418 breast cancer patients treated between 1996 and 2015 in Hacettepe University Cancer Institute, were retrospectively analyzed. Among 4418 patients, 210 were diagnosed with ILC and 23 patients diagnosed with pure IPLC. In this present study, clinicopathological characteristics, disease free survival (DFS) and overall survival (OS) of patients with ILC and IPLC were compared. This study design is one of the rare face to face comparison of pure IPLC and ILC. Patients with IPLC had an increased rate of higher histologic grade, extracapsular extension, lymphovascular invasion and lower percentage of hormone positivity than those of patients with ILC. During the follow-up time, IPLC group experienced 4 cases (17.3%) of recurrence, 5 cases (21.7%) of death and 2 cases (8.7%) of progression in 3 metastatic patients compared to that of 27 cases (12.9%) of recurrence, 29 cases (13,8%) of death and 14 cases (6.7%) of progression in 19 metastatic patients in the ILC group. Patients with IPLC had a worse DFS and OS duration than patients with ILC (P = 0.02 for OS, P = 0.04 for DFS). In conclusion, IPLC is a different and a special breast cancer subtype. This study suggests that IPLC is a distinct clinical entity with an advanced stage and more aggressive clinical course. Patients with IPLC reveal poorer prognostic factors such as higher histological grade, relative lower percentages of hormone positivity, and increased rate of recurrences resulting in poor clinical outcomes and worse survival. Nowadays, it is observed that current treatment methods for IPLC do not seem as successful as in ILC and failed to be effective. Thence, individual therapies including more aggressive surgery and adjuvant or neoadjuvant chemotherapy even in the earlier stages of breast cancer should be performed for this distinct variant.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 28424130
OWN - NLM
STAT- MEDLINE
DA  - 20170420
DCOM- 20170501
LR  - 20170501
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 83
IP  - 4
DP  - 2017 Apr 01
TI  - Invasive Pleomorphic Lobular Histology Is an Adverse Prognostic Factor on
      Survival in Patients with Breast Cancer.
PG  - 359-364
AB  - Invasive pleomorphic lobular carcinoma (IPLC) is defined to be an uncommon and
      different subtype of classical invasive lobular carcinoma (ILC). This special
      variant is characterized by significant cytological atypia and pleomorphism which
      differs from the cytological uniformity of ILC. IPLC has been shown to have some 
      poor prognostic factors such as axillary node metastasis and higher histological 
      grade which may lead to poor clinical courses including a short relapse time,
      increased risk of recurrence and a decreased survival. The aim of this study is
      to investigate the clinicopathological characteristics and prognosis of IPLC in
      comparison with ILC and also to evaluate if IPLC is a different clinical entity
      compared to ILC. A total number of 4418 breast cancer patients treated between
      1996 and 2015 in Hacettepe University Cancer Institute, were retrospectively
      analyzed. Among 4418 patients, 210 were diagnosed with ILC and 23 patients
      diagnosed with pure IPLC. In this present study, clinicopathological
      characteristics, disease free survival (DFS) and overall survival (OS) of
      patients with ILC and IPLC were compared. This study design is one of the rare
      face to face comparison of pure IPLC and ILC. Patients with IPLC had an increased
      rate of higher histologic grade, extracapsular extension, lymphovascular invasion
      and lower percentage of hormone positivity than those of patients with ILC.
      During the follow-up time, IPLC group experienced 4 cases (17.3%) of recurrence, 
      5 cases (21.7%) of death and 2 cases (8.7%) of progression in 3 metastatic
      patients compared to that of 27 cases (12.9%) of recurrence, 29 cases (13,8%) of 
      death and 14 cases (6.7%) of progression in 19 metastatic patients in the ILC
      group. Patients with IPLC had a worse DFS and OS duration than patients with ILC 
      (P = 0.02 for OS, P = 0.04 for DFS). In conclusion, IPLC is a different and a
      special breast cancer subtype. This study suggests that IPLC is a distinct
      clinical entity with an advanced stage and more aggressive clinical course.
      Patients with IPLC reveal poorer prognostic factors such as higher histological
      grade, relative lower percentages of hormone positivity, and increased rate of
      recurrences resulting in poor clinical outcomes and worse survival. Nowadays, it 
      is observed that current treatment methods for IPLC do not seem as successful as 
      in ILC and failed to be effective. Thence, individual therapies including more
      aggressive surgery and adjuvant or neoadjuvant chemotherapy even in the earlier
      stages of breast cancer should be performed for this distinct variant.
FAU - Sahin, Suleyman
AU  - Sahin S
FAU - Karatas, Fatih
AU  - Karatas F
FAU - Erdem, Gokmen U
AU  - Erdem GU
FAU - Hacioglu, Bekir
AU  - Hacioglu B
FAU - Altundag, Kadri
AU  - Altundag K
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Breast Neoplasms/mortality/*pathology/therapy
MH  - Carcinoma, Lobular/mortality/*pathology/therapy
MH  - Female
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Middle Aged
MH  - Neoplasm Grading
MH  - Neoplasm Invasiveness/*pathology
MH  - Neoplasm Recurrence, Local/mortality/pathology/therapy
MH  - Neoplasm Staging
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
MH  - Turkey/epidemiology
EDAT- 2017/04/21 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/04/21 06:00
PST - ppublish
SO  - Am Surg. 2017 Apr 1;83(4):359-364.

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