Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials.
BACKGROUND
To evaluate whether medullary breast cancer has a better prognosis compared with invasive ductal tumors.


METHODS
Among 12,409 patients, 127 were recorded as invasive medullary tumors and 8096 invasive ductal tumors. Medullary and ductal invasive tumors were compared with regard to stage, age at diagnosis, grade, hormone receptor status, peritumoral vascular invasion, and local and systemic treatment. Pattern of relapse, distant recurrence-free interval (DRFI), and overall survival (OS) were determined for both histological groups. Two cohorts were investigated: a full cohort including the pathologist-determined medullary histology without regard to any other tumor features and a cohort restricted to patients with ER-negative grade 3 tumors.


RESULTS
Fourteen-year DRFI and OS percents for medullary tumors (n = 127) and invasive ductal tumors (n = 8096) of the full cohort were 76% and 64% [hazard ratio (HR) 0.52, P = 0.0005] and 66% and 57% (HR = 0.75, P = 0.03), respectively. For the restricted cohort, 14-year DRFI and OS percents for the medullary (n = 47) and invasive ductal tumors (n = 1407) were 89% and 63% (HR 0.24, P = 0.002) and 74% and 54% (HR = 0.55, P = 0.01), respectively. Competing risk analysis for DRFI favored medullary tumors (HR medullary/ductal = 0.32; 95% confidence interval = 0.13-0.78, P = 0.01).


CONCLUSIONS
Medullary tumors have a favorable prognosis compared with invasive ductal tumors.
Breast Center, Kantonsspital, St Gallen; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland. Electronic address: jens.huober@med.uni-duesseldorf.de.
J
J
Huober
IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston; Frontier Science and Technology Research Foundation, Boston, USA.
S
S
Gelber
Department of Medicine, European Institute of Oncology, Milan, Italy; Swiss Center for Breast Health, Sant'Anna Clinics, Lugano-Sorengo, Switzerland.
A
A
Goldhirsch
International Breast Cancer Study Group and Australian New Zealand Breast Cancer Trials Group, University of Sydney, Sydney, Australia.
A S
AS
Coates
Division of Pathology and Laboratory Medicine, IBCSG Central Pathology Office, European Institute of Oncology, University of Milan, Milan, Italy.
G
G
Viale
Department of Pathology, Kantonsspital, St Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland.
C
C
Öhlschlegel
Frontier Science and Technology Research Foundation, Boston, USA.
K N
KN
Price
IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston; Frontier Science and Technology Research Foundation, Boston, USA; Department of Biostatistics, Harvard School of Public Health, Harvard Medical School.
R D
RD
Gelber
IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston; Department of Biostatistics, Harvard School of Public Health, Harvard Medical School.
M M
MM
Regan
Breast Center, Kantonsspital, St Gallen; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland.
B
B
Thürlimann
D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018276:Carcinoma, Medullary / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D066246:ErbB Receptors / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D066246:ErbB Receptors