Originally published as JCO Early Release 10.1200/JCO.2007.14.9336 on May 5 2008

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Distinct Clinical and Prognostic Features of Infiltrating Lobular Carcinoma of the Breast: Combined Results of 15 International Breast Cancer Study Group Clinical Trials

Bernhard C. Pestalozzi, David Zahrieh, Elizabeth Mallon, Barry A. Gusterson, Karen N. Price, Richard D. Gelber, Stig B. Holmberg, Jurij Lindtner, Raymond Snyder, Beat Thürlimann, Elizabeth Murray, Giuseppe Viale, Monica Castiglione-Gertsch, Alan S. Coates, Aron Goldhirsch

From the University Hospital, Zürich; International Breast Cancer Study Group (IBCSG) Coordinating Center and Swiss Group for Clinical Cancer Research (SAKK), Bern; Senology Center of Eastern Switzerland, Kantonsspital, St. Gallen; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; IBCSG Statistical Center; Dana-Farber Cancer Institute; Frontier Science and Technology Research Foundation; Harvard School of Public Health, Boston, MA; Division of Cancer Sciences and Molecular Pathology, Faculty of Medicine, University of Glasgow, United Kingdom; Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden; The Institute of Oncology, Ljubljana, Slovenia; Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria; University of Sydney, Sydney, New South Wales, Australia; Groote Shuur Hospital; University of Cape Town, Cape Town, South Africa; and Division of Pathology and Laboratory Medicine and Department of Medicine, European Institute of Oncology, University of Milan, Milan, Italy

Corresponding author: Bernhard C. Pestalozzi, MD, Department of Oncology, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland; e-mail: bernhard.pestalozzi{at}usz.ch

Purpose To determine how patients with infiltrating lobular carcinoma (ILC) differ from patients with the more common infiltrating ductal carcinoma (IDC) with regard to patient and tumor factors, local treatment, and patterns of recurrence.

Patients and Methods Twelve thousand two hundred six breast cancer patients entered onto 15 International Breast Cancer Study Group trials between 1978 and 2002 were categorized as having ILC, IDC, or other/mixed types.

Results Seven hundred sixty-seven tumors (6.2%) were classified as ILC, 8,607 (70.5%) were classified as IDC, and 2,832 (23.2%) were classified as other. The analysis is limited to the 9,374 patients categorized as either pure IDC or ILC. The median follow-up time was 13 years. Compared with IDC, ILC was associated with older age; larger, better differentiated, and estrogen receptor (ER)–positive tumors; and less vessel invasion. Mastectomy was used more frequently for ILC (P < .01). There was a significant (P < .01) early advantage in disease-free survival and overall survival for the ILC cohort followed by a significant (P < .01) late advantage for the IDC cohort after 6 and 10 years, respectively. Similar patterns were observed in cohorts defined by ER status. ILC was associated with an increased incidence of bone events but a decrease in regional and lung events (all P < .01).

Conclusion ILC is more than a histologic variant of breast cancer. The diagnosis of ILC carries distinct prognostic and biologic implications.

published online ahead of print at www.jco.org on May 5, 2008.

Supported in part by Swiss Group for Clinical Cancer Research (SAKK), Frontier Science and Technology Research Foundation (FSTRF), The Cancer Council Australia, Australian New Zealand Breast Cancer Trials Group (National Health Medical Research Council), National Cancer Institute (Grant No. CA-75362), Swedish Cancer Society, Cancer Research Switzerland/Oncosuisse, Cancer Association of South Africa, and Foundation for Clinical Cancer Research of Eastern Switzerland (OSKK).

Presented in part at the 30th Annual San Antonio Breast Cancer Symposium, December 13-16, 2007, San Antonio, TX.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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