Is pleomorphic lobular carcinoma really a distinct clinical entity?
Is pleomorphic lobular carcinoma really a distinct clinical entity?
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DOI：
10.1002/jso.21121
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发表时间：
2008-10-01
影响因子：
2.5
通讯作者：
Sclafani, Lisa M.
中科院分区：
文献类型：
--
作者：
Buchanan, Claire L.;Flynn, Laurie W.;Sclafani, Lisa M.
背景：对多形性小叶癌（pleomorphic lobular carcinoma， PLC）临床行为的研究仅限于小系列，临床管理策略尚未建立。我们将PLC与经典的ILC和浸润性导管癌（IDC）进行比较。方法：收集1996年9月~ 2003年5月5635例接受原发性手术及前哨淋巴结活检的乳腺癌患者的临床及组织病理学资料。481例（8.5%）患者被诊断为ILC；3978（70.6%）。在ILC患者中，356例（74%）患者有可用于病理复查的材料，包括我们的研究人群：52例被归类为PLC；经典型ILC 298例；6例重新归类为IDC。我们使用Wilcoxon秩和和Fisher精确检验比较了PLC、ILC和IDC患者的临床、病理和治疗因素。结果：PLC比ILC和IDC大（20比15比13，P < 0.001），阳性淋巴结更多（中位数1比0比0，P < 0.05），更频繁地需要乳房切除术（63.5%比38.7%比28.8%,P < 0.001）。此外，与ILC患者相比，PLC患者有更多的转移性疾病（11.5%比3.7%,P < 0.05）。结论：这些发现表明PLC是一种独特的临床实体，出现在更晚期，可能需要更积极的手术和辅助治疗。
Background: Attempts to define the clinical behavior of pleomorphic lobular carcinoma (PLC) have been limited to small series, and clinical management strategies have yet to be established. We describe our experience with PLC as compared to classic ILC and invasive ductal carcinoma (IDC).Methods: From 9/1996 to 5/2003, clinical and histopathologic data for 5,635 patients undergoing primary surgical treatment and sentinel lymph node biopsy for breast cancer were collected. Four hundred eighty one (8.5%) patients were diagnosed with ILC; 3,978 (70.6%) with IDC. Of those with ILC, 356 (74%) patients had material available for pathologic re-review and comprise our study population: 52 were classified as PLC; 298 were classified as classic ILC; and 6 cases were reclassified as IDC. We compared clinical, pathologic, and treatment factors for patients with PLC, ILC, and IDC using the Wilcoxon rank sum and Fisher's exact tests.Results: PLC were larger than ILC and IDC (20 vs. 15 vs. 13, P < 0.001), had more positive nodes (median 1 vs. 0 vs. 0, P < 0.05) and more frequently required mastectomy (63.5% vs. 38.7% vs. 28.8%, P < 0.001). In addition, more patients with PLC had developed metastatic disease compared to patients with ILC (11.5% vs. 3.7%, P < 0.05).Conclusions: These findings suggest that PLC is a distinct clinical entity that presents at a more advanced stage and may require more aggressive surgical and adjuvant treatment.