Clincai Path of 57 Patiens
Clincai Path of 57 Patiens
Clincai Path of 57 Patiens
n Abstract: Apocrine carcinoma is a rare, unique, and morphologically distinctive type of invasive ductal carcinoma
(IDC). The features of invasive apocrine carcinoma (IAC) and their possible prognostic implications have not been fully
investigated. To this end, we examined the clinicopathologic characteristics and outcome of patients with IAC and com-
pared these factors with those of patients with IDC. Out of 2,055 breast cancer patients who had undergone breast surgery
between 1995 and 2005, 57 patients of IAC and 1,583 patients of IDC were analyzed. The mean ages of the patients with
IAC and of those with IDC were 58.5 ± 10.9 years and 54.4 ± 11 years, respectively (p = 0.006). The percentages of
patients with axillary nodal metastasis and lymphatic invasion were significantly lower in the IAC group than in the IDC
group (p = 0.03 and 0.02, respectively). The percentage of estrogen and progesterone receptor negativity was higher in the
IAC group than in the IDC group (p < 0.001). After a median follow-up period of 49 months (range, 1–133 months), seven
(12%) patients with IAC and 244 (15%) patients with IDC had experienced recurrences. Three (5%) patients with IAC and
125 (8%) patients with IDC died of recurrent breast cancer. No significant differences in the relapse-free survival (p = 0.83)
and overall survival (p = 0.75) rates were observed between the two groups. Although IAC and IDC have different clinico-
pathologic characteristics, the prognoses of patients with these diseases are similar. n
Key Words: apocrine carcinoma, axillary nodal metastasis, breast cancer, hormone receptor
round centrally to the eccentrically located malignant Table 1. Comparison of Clinicopathologic Char-
nuclei containing prominent nucleoli. On the other acteristics between Invasive Apocrine Carcinoma
hand, neoplasms in which less than 80% of the tumor and Invasive Ductal Carcinoma
cells exhibited apocrine cytologic features were defined Invasive Invasive
as IDC with apocrine features. Histologic grading was apocrine ductal
performed according to the modified Bloom–Richard- caricnoma carcinoma
(n = 57) (n = 1583) p
son histologic grading scale for infiltrating carcinomas.
The estrogen receptor (ER) and progesterone receptor Mean age (years) 58.5 ± 10.9 54.4 ± 11.0 0.006
Menopausal status
(PgR) status was assessed using an enzyme immuno- Pre 19 712 0.08
assay or immunohistochemistry. For the enzyme Post 38 871
Stage
immunoassays, the upper cutoff values for ER and I 20 532 0.35
PgR in the cytosol fraction were set at 13 fmol ⁄ mg II 34 871
III 3 180
and 10 fmol ⁄ mg of protein, respectively. Immuno- Tumor size (cm)
staining for ER and PgR was considered positive when )2.0 20 564 0.55
2.1–5.0 34 876
a distinct nuclear localization was found in 10% or
5.1–25.0 3 143
more of the cells. The human epidermal growth Pathologic nodal metastasis
factor receptor type 2 (HER2) status was evaluated Negative 41 925 0.03
Positive 15 646
using the Herceptest (DakoCytomation, Carpinteria, Unknown* 1 12
CA). Tumors were considered positive if 10% or more Lymphatic invasion
Negative 47 1075 0.02
tumor cells had distinct circumferential membrane Positive 10 502
staining. Unknown* 0 6
Vascular invasion
Negative 33 825 0.41
Statistical Analysis Positive 24 750
Unknown* 0 6
Relapse-free survival was defined as the time until
Histologic grade
the first occurrence of disease recurrence at any site. 1 9 207 0.23
Overall survival was defined as the time until death 2 32 751
3 16 619
from any cause. Statistical differences between the Unknown* 0 6
two groups were analyzed using the chi-squared test ER
Negative 48 580 <0.001
(or the Fisher’s exact probability test). Survival Positive 9 913
curves were produced according to the Kaplan–Meier Unknown* 0 90
PgR
method and were compared using the log-rank test. Negative 45 701 <0.001
statmate III (for Macintosh) was used for the statis- Positive 12 792
Unknown* 0 90
tical analysis. A p-value of <0.05 was considered
HER2
significant. 0–2+ 35 514 0.74
3+ 6 102
Unknown* 16 967
Clinicopatholgic Characteristics
The clinicopathologic characteristics of the patients Survival
with IAC and of those with IDC are shown in Table 1. The relapse-free survival and overall survival curves
The patients with IAC were older (p = 0.006) and had are shown in Figure 1. The median follow-up time
a lower frequency of axillary nodal metastasis was 49 months (range, 1–133 months). Seven (12%)
(p = 0.03), a lower frequency of lymphatic invasion patients in the IAC group and 244 (15%) patients in
(p = 0.02), and a lower frequency of ER and PgR pos- the IDC group developed recurrences (Table 2). The
itivity (p < 0.001) than those with IDC. On the other numbers of patients with loco-regional recurrence, dis-
hand, no significant differences with regard to meno- tant metastasis, and distant metastasis with loco-regio-
pausal status, pathologic tumor size, stage, histologic nal recurrence were 5 (9%), 2 (3%), and 0 (0%) in
grade, vascular invasion, or HER2 status were the IAC group and 76 (5%), 133 (8%), and 35 (2%)
observed between the two groups. in the IDC group, respectively. Three (5%) patients
166 • tanaka et al.
100 100
Relapse-free survival (%)
80 80
20 20
Figure 1. Relapse-free survival (p = 0.83)
and overall survival curves (p = 0.75) of
0 0
patients with invasive apocrine carcinoma
0 2 4 6 8 10 0 2 4 6 8 10 (full line) and invasive ductal carcinoma (dot-
Time after operation (years) Time after operation (years) ted line).
Table 2. Comparison of Recurrence and Survival between the two groups among patients without axil-
between Invasive Apocrine Carcinoma and Inva- lary nodal metastases (p = 0.29), with axillary nodal
sive Ductal Carcinoma metastases (p = 0.49), with ER negativity (p = 0.27),
or with ER positivity (p = 0.74).
Invasive Invasive
apocrine ductal
caricnoma carcinoma
(n = 57) (n = 1583) p DISCUSSION
Recurrence 7 244 0.83 We reviewed several previously reported patients of
Loco-regional 5 76
Distant 2 133
apocrine carcinoma (Table 3). Apocrine carcinoma
Distant with loco-regional 0 35 accounted for 3% of all breast cancers treated at our
Survival
institution. The incidence tended to be higher than
Death because of breast cancer 3 125 0.75
those mentioned in other reports. However, the inci-
dence of apocrine carcinoma varied considerably from
with IAC and 125 (8%) patients with IDC died of one report to another. Differences in the pathologic
breast cancer. No significant differences in the relapse- criteria of apocrine carcinoma may result in the vari-
free survival (p = 0.83) and overall survival (p = 0.75) ety in the reported incidences.
periods of the two groups were observed. We also Apocrine carcinoma has a unique hormone receptor
examined the overall survival of patients stratified profile. The percentages of IAC patients with ER and
according to nodal status and ER status. No signifi- PgR positivity were significantly low (16% and 21%,
cant differences in overall survival were observed respectively). The reason for the low percentage of ER
Nodal
No. of Incidence Age Tumor metastases
Author [year] (ref.) patients reported mean size (cm) positivity ER positivity PgR positivity
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