Journal Article and Summary Rotation 4 Surgery

     The name of the article of the article I chose is “Comparison of clinical outcomes between luminal invasive ductal carcinoma and luminal invasive lobular carcinoma” written by Adachi et al. The article was published in BMC Cancer in March of 2016.  The article is centered around a retrospective case control study. The study is based on four thousand one hundred ten breast cancer patients were treated at the Aichi Cancer Center Hospital from 2003 to 2012. The study identified 1,661 cases with luminal IDC and 105 cases with luminal classical ILC. It examined baseline characteristics, clinical outcomes, and prognostic factors of luminal ILC. It was found that the prognosis of luminal ILC was significantly worse than that of luminal IDC. The rates of 5-year disease free survival (DFS) were 91.9 % and 88.4 % for patients with luminal IDC and luminal ILC, respectively. The rates of 5-year overall survival (OS) were 97.6 % and 93.1 % for patients with luminal IDC and luminal ILC respectively. Luminal ILC tended to have worse disease-free survival than luminal IDC in the large tumor group. In addition, luminal ILC had a significantly worse disease-free survival and overall survival than luminal IDC in node-positive patients. Survival curves showed that the prognosis for ILC became worse than IDC over time. Multivariate analysis showed that ILC was an important factor related to higher risk of recurrence of luminal type breast cancer, even when tumor size, lymph node status and histological grade were considered. The article had many limitations, one limitation of this study is that the results were based on a retrospective analysis. HER2 status could be inconsistent during the study period due to several changes of the definition of HER2 positivity. Moreover, sufficient data of PgR and Ki-67 required to distinguish between luminal A and luminal B were not available, therefore they defined luminal type as ER positive and HER2 negative in this study and it could not discuss about a difference between luminal A ILC and luminal B ILC. Despite some limitations, this is the first study which suggests that ILC is an independent prognostic factor for luminal type breast cancer, and the results suggest that it may be necessary to reconsider the clinical approach for luminal ILC. To verify this hypothesis, several gene-expression profiling studies will be required to determine whether ILC has different patterns of gene expression from IDC even if histological grade and molecular subtypes are matched. Therefore, other scientific approaches such as gene-expression profiling studies may provide answers to the questions raised about clinical behavior and systemic approaches to ILC.

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