Adjuvant therapy may not be justified for tubular carcinoma
MedWire News: Patients with tubular carcinoma (TC) of the breast have a better prognosis than those with grade 1 ductal carcinoma and may not require adjuvant chemotherapy, UK research shows.
“Although TC is known to have a favorable prognosis, it is still unknown whether this subtype represents a distinct type of breast carcinoma or whether it behaves like other low-grade luminal A–type breast carcinomas,” remark Emad Rakha (Nottingham University Hospitals) and colleagues.
To investigate, Rakha and team performed a retrospective analysis of a large well-characterized series of breast cancers and assessed the clinicopathologic and molecular features, and prognoses of TC compared with grade 1 ductal carcinomas of the breast.
Of 2608 primary invasive breast carcinomas from women aged 70 years or younger, the researchers identified 113 (4.3%) pure TCs and 207 (7.9%) grade 1 ductal carcinomas.
When compared with grade 1 ductal carcinoma, TC was more likely to be detected on mammographic screening, had smaller median size, and less frequently showed lymphovascular invasion.
Both tumor types were typically estrogen receptor-positive and human epidermal growth factor receptor 2-negative and had a low proliferative fraction. TC showed less expression of the prognostic marker P-cadherin and a non-significant trend toward more expression of luminal cytokeratins than grade 1 ductal carcinomas.
Survival analysis revealed that compared with grade 1 ductal carcinoma patients, TC patients had significantly longer disease-free survival and breast cancer–specific survival, independent of other prognostic factors.
Of note, none of the patients with TC developed distant metastasis or died from the disease without an intervening recurrence as invasive carcinoma of different histologic type. “We conclude that the biologic behavior of TC is excellent and is more favorable than that of grade 1 ductal carcinoma,” write Rakha and co-authors in the Journal of Clinical Oncology.
“In addition, patients with TC seem to have a close to normal life expectancy, and as a consequence, adjuvant systemic therapy may not be justified in their routine management.”
However, the researchers caution: “Patients with TC may be at risk of developing second primary carcinomas in the contralateral breast, which may be of higher grade and poorer potential prognostic outcome.”.
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By Laura Dean