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Purpose <p>To evaluate differences in clinical outcomes, treatments received, recurrence, and sociodemographic characteristics in patients with triple-negative breast cancer (TNBC) classified as invasive lobular carcinoma (TNBC–ILC) or invasive carcinoma of no special type (TNBC–NST).</p> Methods <p>Using national registry data, we conducted a retrospective, population-based cohort study of 6449 women diagnosed with primary TNBC (stratified by histological subtype) in Sweden (2007–2021). Clinical and treatment data were analyzed using descriptive statistics, logistic regression, machine learning (Boruta/XGBoost), and Cox proportional hazards models adjusted for patient age, tumor size, grade, nodal status, comorbidities, and receipt of adjuvant chemotherapy (ACT).</p> Results <p>TNBC–ILC accounted for 2.7% of all TNBC cases and affected older patients (median age 70 vs 62&#xa0;years). Compared to TNBC–NST, TNBC–ILC had lower Ki-67, fewer high-grade tumors, higher T stage, and greater socioeconomic vulnerability. Machine learning identified age and post-operative tumor size as key predictive features of TNBC–ILC. ACT was administered to 40% of TNBC–ILC versus 59% of TNBC–NST cases (P &lt; 0.001), with a survival benefit observed only in TNBC–NST. TNBC–ILC patients aged 50–64&#xa0;years were less likely to receive ACT. Despite lower proliferative activity, TNBC–ILC was associated with worse overall (OS; adj-HR 1.39, 95% CI 1.04–1.86) and disease-specific survival (DSS; adj-HR 1.98, 95% CI 1.41–2.79), particularly in patients ≥ 50&#xa0;years of age. TNBC–ILC patients ≥ 75&#xa0;years had the poorest 5-year survival (DSS 55%; OS 42%).</p> Conclusions <p>TNBC–ILC is a distinct subgroup with older age, lower grade and Ki-67, undertreatment, and poorer survival, emphasizing the need for age- and subtype-specific treatment strategies.</p>

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Worse survival despite indolent features for triple-negative invasive lobular carcinoma: a Swedish nationwide registry-based study

  • 期刊论文

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  • 发表日期：

    2025年11月21日

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  • Jenny Nyqvist-Streng,
  • Chaido Chamalidou,
  • Anikó Kovacs,
  • Toshima Z. Parris

摘要

Purpose

To evaluate differences in clinical outcomes, treatments received, recurrence, and sociodemographic characteristics in patients with triple-negative breast cancer (TNBC) classified as invasive lobular carcinoma (TNBC–ILC) or invasive carcinoma of no special type (TNBC–NST).

Methods

Using national registry data, we conducted a retrospective, population-based cohort study of 6449 women diagnosed with primary TNBC (stratified by histological subtype) in Sweden (2007–2021). Clinical and treatment data were analyzed using descriptive statistics, logistic regression, machine learning (Boruta/XGBoost), and Cox proportional hazards models adjusted for patient age, tumor size, grade, nodal status, comorbidities, and receipt of adjuvant chemotherapy (ACT).

Results

TNBC–ILC accounted for 2.7% of all TNBC cases and affected older patients (median age 70 vs 62 years). Compared to TNBC–NST, TNBC–ILC had lower Ki-67, fewer high-grade tumors, higher T stage, and greater socioeconomic vulnerability. Machine learning identified age and post-operative tumor size as key predictive features of TNBC–ILC. ACT was administered to 40% of TNBC–ILC versus 59% of TNBC–NST cases (P < 0.001), with a survival benefit observed only in TNBC–NST. TNBC–ILC patients aged 50–64 years were less likely to receive ACT. Despite lower proliferative activity, TNBC–ILC was associated with worse overall (OS; adj-HR 1.39, 95% CI 1.04–1.86) and disease-specific survival (DSS; adj-HR 1.98, 95% CI 1.41–2.79), particularly in patients ≥ 50 years of age. TNBC–ILC patients ≥ 75 years had the poorest 5-year survival (DSS 55%; OS 42%).

Conclusions

TNBC–ILC is a distinct subgroup with older age, lower grade and Ki-67, undertreatment, and poorer survival, emphasizing the need for age- and subtype-specific treatment strategies.