Endocrine-responsive lobular carcinoma of the breast: Features associated with risk of late distant recurrence

Fabio Conforti, Laura Pala, Eleonora Pagan, Giuseppe Viale, Vincenzo Bagnardi, Giulia Peruzzotti, Tommaso De Pas, Nadia Bianco, Rossella Graffeo, Elena Guerini Rocco, Andrea Vingiani, Richard D. Gelber, Alan S. Coates, Marco Colleoni, Aron Goldhirsch

Research output: Contribution to journalArticlepeer-review


Background: Invasive lobular carcinomas (ILCs) account for 10-15% of all breast cancers. They are characterized by an elevated endocrine responsiveness and by a long lasting risk of relapse over time. Here we report for the first time an analysis of clinical and pathological features associated with the risk of late distant recurrence in ILCs. Patients and methods: We retrospectively analyzed all consecutive patients with hormone receptor-positive ILC operated at the European Institute of Oncology (EIO) between June 1994 and December 2010 and scheduled to receive at least 5 years of endocrine treatment. The aim was to identify clinical and pathological variables that provide prognostic information in the period beginning 5 years after definitive surgery. The cumulative incidence of distant metastases (CI-DM) from 5 years after surgery was the prospectively defined primary endpoint. Results: One thousand eight hundred seventy-two patients fulfilled the inclusion criteria. The median follow-up was 8.7 years. Increased tumor size and positive nodal status were significantly associated with higher risk of late distant recurrence, but nodal status had a significant lower prognostic value in late follow-up period (DM-HR, 3.21; 95% CI, 2.06-5.01) as compared with the first 5 years of follow-up (DM-HR, 9.55; 95% CI, 5.64-16.2; heterogeneity p value 0.002). Elevated Ki-67 labeling index (LI) retained a significant and independent prognostic value even after the first 5 years from surgery (DM-HR, 1.81; 95% CI 1.19-2.75), and it also stratified the prognosis of ILC patients subgrouped according to lymph node status. A combined score, obtained integrating the previously validated Clinical Treatment Score post 5 years (CTS5) and Ki-67 LI, had a strong association with the risk of late distant recurrence of ILCs. Conclusion: We identified factors associated with the risk of late distant recurrence in ER-positive ILCs and developed a simple prognostic score, based on data that are readily available, which warrants further validation.

Original languageEnglish
Article number153
JournalBreast Cancer Research
Issue number1
Publication statusPublished - Dec 30 2019


  • KiCST5
  • Late distant recurrence risk
  • Lobular carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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