title: Metastatic carcinoma of the breast with tubular features: differences compared with metastatic ductal carcinoma of no specific type.
abstract: OBJECTIVE
  To compare the metastatic pattern at presentation and the prognosis with metastases of 48 patients with carcinomas with tubular features (45 tubular mixed and three pure tubular) and 302 patients with tumours of ductal of no special type (DNST).
  
  
  METHODS
  We carried out a retrospective study from a prospectively maintained database of all patients who developed metastatic disease from carcinoma of the breast in Nottingham, U.K., since 1997. We recorded site of first presentation with metastatic disease, radiological features, histological features and characteristics of the primary tumour.
  
  
  RESULTS
  The group of patients with tubular features were older at metastatic presentation (63.9 years vs 59.6 years; P=0.012), had a longer disease-free interval (87 months vs 34 months: P<0.001) and a longer survival with metastases (P<0.002). This group were less likely to have liver metastases (23% vs 41%; P=0.028), in particular multiple liver metastases (50% vs 71%; P=0.015) than the patients with DNST. Other factors known to be associated with prolonged survival, such as low histological grade of the primary invasive tumour and positive oestrogen receptor (ER) status, were more common in the group of patients with tumours with tubular features (Grade 1: 33% vs 3%; Grade 2: 42% vs 25%; Grade 3: 25% vs 72%; P<0.001), (ER positivity 76% vs 52%; P=0.009). When patients with grade 2 tumours were compared, the age at metastatic presentation, disease-free interval and the presence of multiple liver metastases were still significantly different between the two groups.
  
  
  CONCLUSIONS
  Patients with metastatic breast carcinoma with tubular features have a longer survival with metastases than patients with metastatic DNST carcinoma. This improved survival can be explained by better well-recognised prognostic features, such as metastatic site pattern, histological grade, ER status and disease-free interval.
authors.affiliation: Nottingham Breast Institute, Nottingham City Hospital, Nottingham, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Hamilton
authors.forename: A J
authors.initials: AJ
authors.lastname: Evans
authors.forename: S E
authors.initials: SE
authors.lastname: Pinder
authors.forename: J J
authors.initials: JJ
authors.lastname: James
authors.forename: E
authors.initials: E
authors.lastname: Gutteridge
authors.forename: E J
authors.initials: EJ
authors.lastname: Cornford
authors.forename: H C
authors.initials: HC
authors.lastname: Burrell
authors.forename: S Y
authors.initials: SY
authors.lastname: Chan
authors.forename: J F
authors.initials: JF
authors.lastname: Robertson
authors.forename: K L
authors.initials: KL
authors.lastname: Cheung
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D017668:Age of Onset; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology*; D044584:Carcinoma, Ductal / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies
chemical_list: D011960:Receptors, Estrogen