Rak gruczołowy in situ – Rokowania, prognozy i postęp choroby

Rak gruczołowy in situ
Rokowania, prognozy i postęp choroby

Rak gruczołowy in situ (LCIS) to rzadki stan przedrakowy piersi, stanowiący 1-2% wszystkich nowotworów piersi i 5,3% zmian in situ, który znacząco zwiększa ryzyko rozwoju inwazyjnego raka piersi (20-30% vs. 12% w populacji ogólnej). LCIS jest bezobjawowy i najczęściej wykrywany przypadkowo w badaniach histopatologicznych. Czynniki prognostyczne wpływające na całkowite przeżycie (OS) obejmują wiek (lepsze rokowanie u pacjentek <40 lat), rasę (gorsze u czarnoskórych i rdzennych Amerykanów) oraz status receptorów hormonalnych (dłuższe przeżycie u PR+). Współwystępowanie LCIS z inwazyjnym rakiem piersi zwiększa ryzyko raka drugiej piersi 3,3-krotnie (3,3% vs. 1,0%). Nowy podpis molekularny LobSig wykazuje wysoką wartość prognostyczną, przewyższając tradycyjny Nottingham Prognostic Index, szczególnie w guzach ILC stopnia 2 i 3, i może mieć zastosowanie w prognozowaniu przebiegu LCIS.

Wprowadzenie do raka gruczołowego in situ (LCIS)
Ryzyko rozwoju raka inwazyjnego po diagnozie LCIS
Czynniki prognostyczne w LCIS

Czynniki demograficzne i kliniczne
Znaczenie współwystępowania LCIS z rakiem inwazyjnym
Nowe markery prognostyczne – LobSig

Porównanie rokowania LCIS i DCIS
Wpływ leczenia na rokowanie
Zalecenia dotyczące obserwacji po diagnozie LCIS
Wyzwania w prognozowaniu LCIS
Podsumowanie rokowania w LCIS

Kolejne rozdziały

Wprowadzenie do raka gruczołowego in situ (LCIS)

Rak gruczołowy in situ (ang. Lobular carcinoma in situ, LCIS) to rzadki stan przedrakowy gruczołu piersiowego, który stanowi około 1-2% wszystkich nowotworów piersi oraz 5,3% zmian in situ.¹²³ Chociaż LCIS nie jest nowotworem złośliwym, jego obecność znacząco zwiększa ryzyko rozwoju inwazyjnego raka piersi w przyszłości – zarówno raka zrazikowego, jak i przewodowego.⁴⁵

LCIS charakteryzuje się brakiem objawów klinicznych i jest najczęściej wykrywany przypadkowo podczas badań histopatologicznych wykonywanych z innych przyczyn. Istotne jest, że LCIS nie jest bezpośrednim prekursorem raka inwazyjnego, ale raczej markerem zwiększonego ryzyka podobnym do wieku czy historii rodzinnej.⁶

Ryzyko rozwoju raka inwazyjnego po diagnozie LCIS

Diagnoza LCIS znacząco zwiększa ryzyko rozwoju inwazyjnego raka piersi. Podczas gdy przeciętne ryzyko rozwoju raka piersi u kobiet wynosi około 12%, u pacjentek z LCIS wzrasta ono do 20-30%.⁷ Badania wskazują, że około 1 na 10 osób z LCIS rozwinie rak przewodowy in situ (DCIS) lub inwazyjny rak zrazikowy.⁸

Należy podkreślić, że rozwój inwazyjnego raka piersi z LCIS nie jest natychmiastowy i może nastąpić po 10-15 latach od pierwotnej diagnozy.⁹ Istotnym czynnikiem prognostycznym jest także wiek pacjentki – im młodsza kobieta w momencie diagnozy, tym wyższe ryzyko rozwoju inwazyjnego raka w przyszłości.¹⁰

Czynniki prognostyczne w LCIS

Czynniki demograficzne i kliniczne

Analiza danych z bazy SEER (Surveillance, Epidemiology, and End Results) wykazała kilka istotnych czynników prognostycznych wpływających na całkowite przeżycie (OS) pacjentek z LCIS:¹¹¹²

Wiek w momencie diagnozy – pacjentki zdiagnozowane w wieku poniżej 40 lat wykazują lepsze wskaźniki przeżycia długoterminowego
Rasa – pacjentki rasy czarnej oraz rdzenni Amerykanie/mieszkańcy Alaski wykazują gorsze rokowanie w porównaniu do innych grup etnicznych
Status receptorów hormonalnych – pacjentki z dodatnim statusem receptora progesteronowego (PR+) wykazują dłuższy średni czas przeżycia w porównaniu do pacjentek PR-negatywnych

¹³¹⁴

Znaczenie współwystępowania LCIS z rakiem inwazyjnym

Istotnym czynnikiem prognostycznym jest również współwystępowanie LCIS z inwazyjnym rakiem piersi. Badania wskazują, że około 16,6% pacjentek z inwazyjnym rakiem piersi ma jednocześnie zdiagnozowany LCIS.¹⁵¹⁶ Ta grupa pacjentek charakteryzuje się znacząco wyższym ryzykiem rozwoju raka drugiej piersi (contralateral breast cancer, CBC).

Pacjentki z LCIS współwystępującym z pierwotnym inwazyjnym rakiem piersi mają 3,3-krotnie wyższe ryzyko (95% CI: 1,5-7,3) rozwoju raka drugiej piersi w porównaniu do pacjentek bez LCIS.¹⁷ Częstość występowania raka drugiej piersi w tej grupie wynosi 3,3% w porównaniu do 1,0% u pacjentek bez LCIS.¹⁸¹⁹

Nowe markery prognostyczne – LobSig

W odpowiedzi na potrzebę lepszej stratyfikacji ryzyka u pacjentek z inwazyjnym rakiem zrazikowym (ILC), opracowano nowy podpis molekularny – LobSig. Chociaż LobSig został zaprojektowany głównie dla inwazyjnego raka zrazikowego, może mieć również znaczenie w prognozowaniu przebiegu LCIS, biorąc pod uwagę podobieństwa biologiczne.²⁰

LobSig wykazuje wysoką wartość prognostyczną, szczególnie w guzach ILC stopnia 2 i 3, przewyższając istniejące sygnatury zarówno w analizie jedno-, jak i wieloczynnikowej. Ponadto, LobSig wykazuje większą zdolność prognostyczną niż tradycyjny Nottingham Prognostic Index (NPI).²¹

Szczególnie istotne jest, że LobSig pozwala na przewidywanie wyników z dokładnością 94,6% wśród przypadków klasyfikowanych jako umiarkowanego ryzyka według NPI.²² Przypadki z niekorzystnym rokowaniem przewidywanym przez LobSig były wzbogacone o mutacje w genach ERBB2, ERBB3, TP53, AKT1 i ROS1.²³

Porównanie rokowania LCIS i DCIS

Historycznie LCIS było postrzegane jako łagodniejszy stan w porównaniu do raka przewodowego in situ (DCIS), jednakże nowsze badania sugerują, że długoterminowe rokowanie w LCIS może być podobne do większości przypadków DCIS.²⁴

LCIS nie zawsze jest chorobą indolentną, a jej przebieg może przypominać DCIS. Głównym wyzwaniem pozostaje dokładna definicja patologiczna oraz jasna identyfikacja bardziej agresywnych podtypów, co pozwoliłoby uniknąć inwazyjnych wznów miejscowych.²⁵

Wpływ leczenia na rokowanie

Obecnie nie istnieje standardowe podejście terapeutyczne dla pacjentek z LCIS.²⁶ Według wytycznych NCCN z 2017 roku, usunięcie chirurgiczne jest zalecane po diagnozie LCIS poprzez biopsję gruboigłową.²⁷

Analiza danych z bazy SEER wykazała, że metoda leczenia jest istotnym czynnikiem prognostycznym wpływającym na całkowite przeżycie (OS) pacjentek z LCIS:²⁸

Pacjentki leczone za pomocą lokalnej chirurgii (LA) lub lokalnej chirurgii z radioterapią (LRT) wykazywały lepsze przeżycie całkowite w porównaniu do pacjentek poddanych mastektomii z radioterapią (MRT)
Biorąc pod uwagę koszty medyczne i ryzyko związane z radioterapią, lokalna chirurgia (LA) może być najbardziej odpowiednią terapią dla pacjentek z LCIS

²⁹³⁰

Skuteczność leczenia chirurgicznego potwierdza także obserwacja, że 98% pacjentek z LCIS poddanych leczeniu chirurgicznemu żyje 10 lat po zakończeniu leczenia.³¹

Zalecenia dotyczące obserwacji po diagnozie LCIS

Ze względu na zwiększone ryzyko rozwoju inwazyjnego raka piersi, pacjentki z LCIS wymagają ścisłej obserwacji podczas opieki po zakończeniu leczenia. Dotyczy to zwłaszcza kobiet, u których LCIS zdiagnozowano jednocześnie z inwazyjnym rakiem piersi.³²

Dane sugerują, że u kobiet z LCIS zdiagnozowanym jednocześnie z pierwotnym rakiem piersi (około 16% pacjentek) może być zasadne rozważenie ciągłych badań przesiewowych wysokiego ryzyka w trakcie opieki po zakończeniu leczenia, ze względu na podwyższone ryzyko.³³

Należy jednak podkreślić, że diagnoza LCIS nie oznacza, że pacjentka na pewno rozwinie raka piersi. Oznacza to jedynie wyższe ryzyko, które wynosi około 1 na 10.³⁴

Wyzwania w prognozowaniu LCIS

Mimo postępów w diagnostyce i leczeniu, nadal istnieją znaczące wyzwania w prognozowaniu przebiegu LCIS. Głównym problemem jest brak narzędzi diagnostycznych, które niezawodnie przewidywałyby, kto rozwinie inwazyjnego raka piersi po diagnozie LCIS.³⁵

Jest prawdopodobne, że niektóre pacjentki z LCIS są niedostatecznie leczone, a inne są leczone zbyt agresywnie. Żaden z tych scenariuszy nie jest idealny, co podkreśla znaczenie doskonalenia strategii diagnostycznych.³⁶

Nadal istnieje potrzeba opracowania bardziej precyzyjnych markerów molekularnych i genetycznych, które pomogłyby w identyfikacji pacjentek z wyższym ryzykiem progresji do raka inwazyjnego.³⁷ Podpis molekularny LobSig stanowi obiecujący krok w tym kierunku, ale wymaga dalszych badań i walidacji w kontekście LCIS.³⁸

Podsumowanie rokowania w LCIS

Podsumowując, LCIS stanowi marker zwiększonego ryzyka rozwoju inwazyjnego raka piersi. Chociaż większość pacjentek z LCIS nigdy nie rozwinie raka inwazyjnego, ryzyko jest znacząco wyższe niż w populacji ogólnej, szczególnie u młodszych kobiet i osób z LCIS współwystępującym z rakiem inwazyjnym.³⁹⁴⁰

Czynniki prognostyczne obejmują wiek w momencie diagnozy, rasę, status receptorów hormonalnych oraz metodę leczenia. Lokalna chirurgia wydaje się być najlepszą opcją terapeutyczną dla większości pacjentek z LCIS, zapewniając dobre wyniki długoterminowe.⁴¹

Rozwój nowych markerów molekularnych, takich jak LobSig, może w przyszłości umożliwić bardziej spersonalizowane podejście do prognozowania i leczenia LCIS, co poprawi zarządzanie tym stanem i zmniejszy zarówno niedostateczne, jak i nadmierne leczenie.⁴²

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Materiały źródłowe

#1 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#2 Lobular carcinoma in situ (LCIS) of the breast: is long-term outcome similar to ductal carcinoma in situ (DCIS)? Analysis of 200 cases | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-015-0379-7
Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS. […] LCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). […] The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. […] BCS+WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.
#3 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Lobular carcinoma in situ (LCIS) represents 5.3% of in situ specimens, and is thought to carry a low risk for developing to the invasive lobular breast cancer (ILC). […] There is still no standard care approach for patients with LCIS. […] The overall survival (OS) was calculated by the Kaplan-Meier method. […] Patients treated with LA had superior OS for NS (P = 0.001), MA (P 0.001) and MRT P = 0.018). […] Improved OS was also correlated with younger age (P 0.001), progesterone receptor positive (P = 0.001). […] Black patients had the worst OS (P 0.001). […] The LCIS patients treated with LA or LRT had better survival comparing with other groups. […] Considering the medical expense and the risk of radiotherapy, LA may be the most appropriate therapy for patients with LCIS. […] At present, there is no standardized treatment for LCIS.
#4 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
Lobular carcinoma in situ (LCIS) is a rare breast condition. […] LCIS isn’t breast cancer but it does increase the chance you’ll have breast cancer. […] A diagnosis of LCIS does increase the chance that you’ll develop breast cancer later on. […] While it doesn’t happen often, lobular carcinoma in situ may develop into ductal carcinoma in situ (DCIS) or lobular breast cancer. Studies show that 1 in 10 people with LCIS develop DCIS or lobular breast cancer. […] If you have LCIS, ask your provider to explain what you can expect. […] That depends on your situation, including the type of LCIS that you have. […] If you wonder what to expect, ask your healthcare provider to explain what’s going on in your breast and your treatment options. Understanding your options will help you feel more confident about your plan for living with LCIS.
#5 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#6 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#7 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#8 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
Lobular carcinoma in situ (LCIS) is a rare breast condition. […] LCIS isn’t breast cancer but it does increase the chance you’ll have breast cancer. […] A diagnosis of LCIS does increase the chance that you’ll develop breast cancer later on. […] While it doesn’t happen often, lobular carcinoma in situ may develop into ductal carcinoma in situ (DCIS) or lobular breast cancer. Studies show that 1 in 10 people with LCIS develop DCIS or lobular breast cancer. […] If you have LCIS, ask your provider to explain what you can expect. […] That depends on your situation, including the type of LCIS that you have. […] If you wonder what to expect, ask your healthcare provider to explain what’s going on in your breast and your treatment options. Understanding your options will help you feel more confident about your plan for living with LCIS.
#9 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
LCIS may not become invasive breast cancer, but it can happen. When it does, it can take 10 to 15 years to happen. Even so, treatment often cures invasive breast cancer that started as lobular carcinoma in situ. For example, one analysis of LCIS cases shows that 98% of people who had surgery to treat LCIS were alive 10 years after treatment. […] Receiving an LCIS diagnosis doesn’t mean you’ll develop breast cancer. But it does mean you’re at risk for developing the condition. To be clear, there’s a 1 in 10 chance that will happen. […] Lobular carcinoma in situ means you have a higher risk of developing breast cancer.
#10 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#11 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
NCCN guidelines 2017 pointed out that surgical removal was suggested once LCIS was diagnosed via CNB. […] As for radiotherapy, it is not recommended for application due to the absence of data support. […] In the present study, impacts of various factors on survival outcomes for women with LCIS were analyzed using population-based data from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) database. […] Overall survival (OS) was compared according to different factors. […] Compared with other treatments, LRT was able to achieve longer average OS. […] Patients diagnosed with LCIS at an earlier age ( 40) had longer average lifespan than those at 40. […] Relative to other races, black race and American Indian/Alaska native had poorer prognosis. […] As for hormone receptor status, PR positive patients had longer average survival time than PR negative cases.
#12 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Treatment was an important predictor of OS, with patients underwent LRT and LA demonstrating better survival compared to those who accepted MRT. […] Age at diagnosis was another factor associated with better OS, which was characterized by the better prognosis of patients diagnosed with LCIS at age 40. […] In addition, it was revealed that poor prognostic significance was relevant to the black race. […] PR positive patients showed better OS than PR negative ones, while no significant effects on OS of ER status nor histopathological grade was observed. […] Despite the limitations listed above, to our knowledge, this is the first large population-based study to evaluate impacts of surgical and radiation intervention on survival outcomes of LCIS.
#13 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
NCCN guidelines 2017 pointed out that surgical removal was suggested once LCIS was diagnosed via CNB. […] As for radiotherapy, it is not recommended for application due to the absence of data support. […] In the present study, impacts of various factors on survival outcomes for women with LCIS were analyzed using population-based data from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) database. […] Overall survival (OS) was compared according to different factors. […] Compared with other treatments, LRT was able to achieve longer average OS. […] Patients diagnosed with LCIS at an earlier age ( 40) had longer average lifespan than those at 40. […] Relative to other races, black race and American Indian/Alaska native had poorer prognosis. […] As for hormone receptor status, PR positive patients had longer average survival time than PR negative cases.
#14 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Treatment was an important predictor of OS, with patients underwent LRT and LA demonstrating better survival compared to those who accepted MRT. […] Age at diagnosis was another factor associated with better OS, which was characterized by the better prognosis of patients diagnosed with LCIS at age 40. […] In addition, it was revealed that poor prognostic significance was relevant to the black race. […] PR positive patients showed better OS than PR negative ones, while no significant effects on OS of ER status nor histopathological grade was observed. […] Despite the limitations listed above, to our knowledge, this is the first large population-based study to evaluate impacts of surgical and radiation intervention on survival outcomes of LCIS.
#15 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
Of 1808 patients, 16.6% (n=301) had LCIS concurrent with their index breast cancer. […] Patients with LCIS had a higher rate of subsequent CBC development than those without LCIS (3.3% versus 1.0%, P=.004). […] The risk ratio for patients with LCIS developing subsequent CBC compared with those without LCIS was 3.3 (95% confidence interval [CI]: 1.5-7.3). […] Patients with LCIS diagnosed concurrently with their index breast cancer at surgery are at higher risk for subsequent CBC than those without LCIS. […] The evidence from this study suggest that it may be appropriate for women with LCIS diagnosed alongside an index breast cancer to consider on-going high-risk screening during survivorship care. […] The results of this investigation show that patients with LCIS identified alongside an index invasive breast cancer have a significantly increased risk of future CBC.
#16 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
The prevalence of LCIS in invasive breast cancer surgical specimens was 16.6%, indicating a large subset of patients who may be at increased risk versus the average breast cancer survivor. […] However, those with adjacent LCIS had a significantly higher CBC rate of 3.3% in the same timeframe. […] Our results highlight a subset of patients with LCIS diagnosed alongside an index breast cancer (16%) who may benefit from closer clinical follow-up or increased high-risk screening during initial years of survivorship care, given this elevated risk.
#17 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
Of 1808 patients, 16.6% (n=301) had LCIS concurrent with their index breast cancer. […] Patients with LCIS had a higher rate of subsequent CBC development than those without LCIS (3.3% versus 1.0%, P=.004). […] The risk ratio for patients with LCIS developing subsequent CBC compared with those without LCIS was 3.3 (95% confidence interval [CI]: 1.5-7.3). […] Patients with LCIS diagnosed concurrently with their index breast cancer at surgery are at higher risk for subsequent CBC than those without LCIS. […] The evidence from this study suggest that it may be appropriate for women with LCIS diagnosed alongside an index breast cancer to consider on-going high-risk screening during survivorship care. […] The results of this investigation show that patients with LCIS identified alongside an index invasive breast cancer have a significantly increased risk of future CBC.
#18 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
Of 1808 patients, 16.6% (n=301) had LCIS concurrent with their index breast cancer. […] Patients with LCIS had a higher rate of subsequent CBC development than those without LCIS (3.3% versus 1.0%, P=.004). […] The risk ratio for patients with LCIS developing subsequent CBC compared with those without LCIS was 3.3 (95% confidence interval [CI]: 1.5-7.3). […] Patients with LCIS diagnosed concurrently with their index breast cancer at surgery are at higher risk for subsequent CBC than those without LCIS. […] The evidence from this study suggest that it may be appropriate for women with LCIS diagnosed alongside an index breast cancer to consider on-going high-risk screening during survivorship care. […] The results of this investigation show that patients with LCIS identified alongside an index invasive breast cancer have a significantly increased risk of future CBC.
#19 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
The prevalence of LCIS in invasive breast cancer surgical specimens was 16.6%, indicating a large subset of patients who may be at increased risk versus the average breast cancer survivor. […] However, those with adjacent LCIS had a significantly higher CBC rate of 3.3% in the same timeframe. […] Our results highlight a subset of patients with LCIS diagnosed alongside an index breast cancer (16%) who may benefit from closer clinical follow-up or increased high-risk screening during initial years of survivorship care, given this elevated risk.
#20 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
Invasive lobular carcinoma (ILC) is the most common special type of breast cancer, and is characterized by functional loss of E-cadherin, resulting in cellular adhesion defects. ILC typically present as estrogen receptor positive, grade 2 breast cancers, with a good short-term prognosis. […] Importantly, LobSig status predicted outcome with 94.6% accuracy amongst cases classified as moderate-risk according to Nottingham Prognostic Index in the METABRIC cohort. […] ILC with a poor outcome as predicted by LobSig were enriched with mutations in ERBB2, ERBB3, TP53, AKT1 and ROS1. […] LobSig has the potential to be a clinically relevant prognostic signature and warrants further development. […] Despite clear biological and clinical differences, treatment of IC-NST and ILC remains the same. Prognostication is routinely performed using clinico-pathologic information; namely the Nottingham Prognostic Index (NPI), which comprises tumor size, grade and lymph node status, and an IHC panel to evaluate ER, PR and HER2.
#21 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
The Genomic Grade Index (GGI/MapQuantDx) panel has been shown to be more powerful than grade alone in the ILC population, while MammaPrint has validated value only in node negative ILC patients. […] The clinical utility in ILC of the 21-gene signature, OncotypeDx, remains unclear with two studies showing classification of 42% and 35.5% of patients as being as of intermediate risk. […] LobSig is highly prognostic in unselected ILC, and specifically in grade 2 and grade 3 ILC tumors, as well as to a lesser degree in ER-positive, grade 2 IC-NST cases. […] LobSig outperforms existing signatures in both a univariate and multivariate context, and shows greater prognostic capability than the NPI. […] LobSig is particularly effective in grade 2 ILC tumors, versus all ILC. […] The data presented here supports that LobSig low-risk patients need not receive adjuvant chemotherapy. […] In conclusion, we present the molecular signature, LobSig, which captures the peculiar genomic landscape of ILC tumors, and together with clinico-pathology information, provides a robust mechanism for prognostication in ILC.
#22 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
Invasive lobular carcinoma (ILC) is the most common special type of breast cancer, and is characterized by functional loss of E-cadherin, resulting in cellular adhesion defects. ILC typically present as estrogen receptor positive, grade 2 breast cancers, with a good short-term prognosis. […] Importantly, LobSig status predicted outcome with 94.6% accuracy amongst cases classified as moderate-risk according to Nottingham Prognostic Index in the METABRIC cohort. […] ILC with a poor outcome as predicted by LobSig were enriched with mutations in ERBB2, ERBB3, TP53, AKT1 and ROS1. […] LobSig has the potential to be a clinically relevant prognostic signature and warrants further development. […] Despite clear biological and clinical differences, treatment of IC-NST and ILC remains the same. Prognostication is routinely performed using clinico-pathologic information; namely the Nottingham Prognostic Index (NPI), which comprises tumor size, grade and lymph node status, and an IHC panel to evaluate ER, PR and HER2.
#23 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
Invasive lobular carcinoma (ILC) is the most common special type of breast cancer, and is characterized by functional loss of E-cadherin, resulting in cellular adhesion defects. ILC typically present as estrogen receptor positive, grade 2 breast cancers, with a good short-term prognosis. […] Importantly, LobSig status predicted outcome with 94.6% accuracy amongst cases classified as moderate-risk according to Nottingham Prognostic Index in the METABRIC cohort. […] ILC with a poor outcome as predicted by LobSig were enriched with mutations in ERBB2, ERBB3, TP53, AKT1 and ROS1. […] LobSig has the potential to be a clinically relevant prognostic signature and warrants further development. […] Despite clear biological and clinical differences, treatment of IC-NST and ILC remains the same. Prognostication is routinely performed using clinico-pathologic information; namely the Nottingham Prognostic Index (NPI), which comprises tumor size, grade and lymph node status, and an IHC panel to evaluate ER, PR and HER2.
#24 Lobular carcinoma in situ (LCIS) of the breast: is long-term outcome similar to ductal carcinoma in situ (DCIS)? Analysis of 200 cases | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-015-0379-7
Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS. […] LCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). […] The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. […] BCS+WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.
#25 Lobular carcinoma in situ (LCIS) of the breast: is long-term outcome similar to ductal carcinoma in situ (DCIS)? Analysis of 200 cases | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-015-0379-7
Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS. […] LCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). […] The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. […] BCS+WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.
#26 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Lobular carcinoma in situ (LCIS) represents 5.3% of in situ specimens, and is thought to carry a low risk for developing to the invasive lobular breast cancer (ILC). […] There is still no standard care approach for patients with LCIS. […] The overall survival (OS) was calculated by the Kaplan-Meier method. […] Patients treated with LA had superior OS for NS (P = 0.001), MA (P 0.001) and MRT P = 0.018). […] Improved OS was also correlated with younger age (P 0.001), progesterone receptor positive (P = 0.001). […] Black patients had the worst OS (P 0.001). […] The LCIS patients treated with LA or LRT had better survival comparing with other groups. […] Considering the medical expense and the risk of radiotherapy, LA may be the most appropriate therapy for patients with LCIS. […] At present, there is no standardized treatment for LCIS.
#27 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
NCCN guidelines 2017 pointed out that surgical removal was suggested once LCIS was diagnosed via CNB. […] As for radiotherapy, it is not recommended for application due to the absence of data support. […] In the present study, impacts of various factors on survival outcomes for women with LCIS were analyzed using population-based data from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) database. […] Overall survival (OS) was compared according to different factors. […] Compared with other treatments, LRT was able to achieve longer average OS. […] Patients diagnosed with LCIS at an earlier age ( 40) had longer average lifespan than those at 40. […] Relative to other races, black race and American Indian/Alaska native had poorer prognosis. […] As for hormone receptor status, PR positive patients had longer average survival time than PR negative cases.
#28 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Treatment was an important predictor of OS, with patients underwent LRT and LA demonstrating better survival compared to those who accepted MRT. […] Age at diagnosis was another factor associated with better OS, which was characterized by the better prognosis of patients diagnosed with LCIS at age 40. […] In addition, it was revealed that poor prognostic significance was relevant to the black race. […] PR positive patients showed better OS than PR negative ones, while no significant effects on OS of ER status nor histopathological grade was observed. […] Despite the limitations listed above, to our knowledge, this is the first large population-based study to evaluate impacts of surgical and radiation intervention on survival outcomes of LCIS.
#29 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Lobular carcinoma in situ (LCIS) represents 5.3% of in situ specimens, and is thought to carry a low risk for developing to the invasive lobular breast cancer (ILC). […] There is still no standard care approach for patients with LCIS. […] The overall survival (OS) was calculated by the Kaplan-Meier method. […] Patients treated with LA had superior OS for NS (P = 0.001), MA (P 0.001) and MRT P = 0.018). […] Improved OS was also correlated with younger age (P 0.001), progesterone receptor positive (P = 0.001). […] Black patients had the worst OS (P 0.001). […] The LCIS patients treated with LA or LRT had better survival comparing with other groups. […] Considering the medical expense and the risk of radiotherapy, LA may be the most appropriate therapy for patients with LCIS. […] At present, there is no standardized treatment for LCIS.
#30 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Treatment was an important predictor of OS, with patients underwent LRT and LA demonstrating better survival compared to those who accepted MRT. […] Age at diagnosis was another factor associated with better OS, which was characterized by the better prognosis of patients diagnosed with LCIS at age 40. […] In addition, it was revealed that poor prognostic significance was relevant to the black race. […] PR positive patients showed better OS than PR negative ones, while no significant effects on OS of ER status nor histopathological grade was observed. […] Despite the limitations listed above, to our knowledge, this is the first large population-based study to evaluate impacts of surgical and radiation intervention on survival outcomes of LCIS.
#31 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
LCIS may not become invasive breast cancer, but it can happen. When it does, it can take 10 to 15 years to happen. Even so, treatment often cures invasive breast cancer that started as lobular carcinoma in situ. For example, one analysis of LCIS cases shows that 98% of people who had surgery to treat LCIS were alive 10 years after treatment. […] Receiving an LCIS diagnosis doesn’t mean you’ll develop breast cancer. But it does mean you’re at risk for developing the condition. To be clear, there’s a 1 in 10 chance that will happen. […] Lobular carcinoma in situ means you have a higher risk of developing breast cancer.
#32 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
Of 1808 patients, 16.6% (n=301) had LCIS concurrent with their index breast cancer. […] Patients with LCIS had a higher rate of subsequent CBC development than those without LCIS (3.3% versus 1.0%, P=.004). […] The risk ratio for patients with LCIS developing subsequent CBC compared with those without LCIS was 3.3 (95% confidence interval [CI]: 1.5-7.3). […] Patients with LCIS diagnosed concurrently with their index breast cancer at surgery are at higher risk for subsequent CBC than those without LCIS. […] The evidence from this study suggest that it may be appropriate for women with LCIS diagnosed alongside an index breast cancer to consider on-going high-risk screening during survivorship care. […] The results of this investigation show that patients with LCIS identified alongside an index invasive breast cancer have a significantly increased risk of future CBC.
#33 Prognostic Significance of Lobular Carcinoma In-Situ (LCIS) Diagnosed Alongside Invasive Breast Cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8905200/
The prevalence of LCIS in invasive breast cancer surgical specimens was 16.6%, indicating a large subset of patients who may be at increased risk versus the average breast cancer survivor. […] However, those with adjacent LCIS had a significantly higher CBC rate of 3.3% in the same timeframe. […] Our results highlight a subset of patients with LCIS diagnosed alongside an index breast cancer (16%) who may benefit from closer clinical follow-up or increased high-risk screening during initial years of survivorship care, given this elevated risk.
#34 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
LCIS may not become invasive breast cancer, but it can happen. When it does, it can take 10 to 15 years to happen. Even so, treatment often cures invasive breast cancer that started as lobular carcinoma in situ. For example, one analysis of LCIS cases shows that 98% of people who had surgery to treat LCIS were alive 10 years after treatment. […] Receiving an LCIS diagnosis doesn’t mean you’ll develop breast cancer. But it does mean you’re at risk for developing the condition. To be clear, there’s a 1 in 10 chance that will happen. […] Lobular carcinoma in situ means you have a higher risk of developing breast cancer.
#35 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#36 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#37 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
The Genomic Grade Index (GGI/MapQuantDx) panel has been shown to be more powerful than grade alone in the ILC population, while MammaPrint has validated value only in node negative ILC patients. […] The clinical utility in ILC of the 21-gene signature, OncotypeDx, remains unclear with two studies showing classification of 42% and 35.5% of patients as being as of intermediate risk. […] LobSig is highly prognostic in unselected ILC, and specifically in grade 2 and grade 3 ILC tumors, as well as to a lesser degree in ER-positive, grade 2 IC-NST cases. […] LobSig outperforms existing signatures in both a univariate and multivariate context, and shows greater prognostic capability than the NPI. […] LobSig is particularly effective in grade 2 ILC tumors, versus all ILC. […] The data presented here supports that LobSig low-risk patients need not receive adjuvant chemotherapy. […] In conclusion, we present the molecular signature, LobSig, which captures the peculiar genomic landscape of ILC tumors, and together with clinico-pathology information, provides a robust mechanism for prognostication in ILC.
#38 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
The Genomic Grade Index (GGI/MapQuantDx) panel has been shown to be more powerful than grade alone in the ILC population, while MammaPrint has validated value only in node negative ILC patients. […] The clinical utility in ILC of the 21-gene signature, OncotypeDx, remains unclear with two studies showing classification of 42% and 35.5% of patients as being as of intermediate risk. […] LobSig is highly prognostic in unselected ILC, and specifically in grade 2 and grade 3 ILC tumors, as well as to a lesser degree in ER-positive, grade 2 IC-NST cases. […] LobSig outperforms existing signatures in both a univariate and multivariate context, and shows greater prognostic capability than the NPI. […] LobSig is particularly effective in grade 2 ILC tumors, versus all ILC. […] The data presented here supports that LobSig low-risk patients need not receive adjuvant chemotherapy. […] In conclusion, we present the molecular signature, LobSig, which captures the peculiar genomic landscape of ILC tumors, and together with clinico-pathology information, provides a robust mechanism for prognostication in ILC.
#39 Lobular Carcinoma in Situ (LCIS)
https://my.clevelandclinic.org/health/diseases/21791-lobular-carcinoma-in-situ-lcis
LCIS may not become invasive breast cancer, but it can happen. When it does, it can take 10 to 15 years to happen. Even so, treatment often cures invasive breast cancer that started as lobular carcinoma in situ. For example, one analysis of LCIS cases shows that 98% of people who had surgery to treat LCIS were alive 10 years after treatment. […] Receiving an LCIS diagnosis doesn’t mean you’ll develop breast cancer. But it does mean you’re at risk for developing the condition. To be clear, there’s a 1 in 10 chance that will happen. […] Lobular carcinoma in situ means you have a higher risk of developing breast cancer.
#40 Understanding Lobular Carcinoma In Situ (LCIS) | Breast Cancer Research Foundation
https://www.bcrf.org/about-breast-cancer/lcis-lobular-carcinoma-in-situ/
Lobular carcinoma in situ (LCIS): Its something most women have never heard ofa benign, invisible breast condition with no symptomsbut a diagnosis greatly increases your risk for breast cancer. […] LCIS is not generally thought to be a precursor to invasive breast cancer. They are more accepted as a marker of increased risk of invasive breast cancer, similar to age or family history. Women who develop breast cancer after an LCIS diagnosis can be diagnosed with either invasive lobular or ductal carcinoma, which can grow in the same breast as the LCIS or in the other breast. […] The average risk of a woman developing breast cancer in her lifetime is 12 percent. That risk increases to 20 to 30 percent if a woman has been diagnosed with LCIS. The younger a woman is at diagnosis, the higher the risk. […] Because no diagnostic tools currently exist that reliably predict who will develop invasive breast cancer after an LCIS diagnosis, it is likely that some women with LCIS are undertreated, and some women are overtreated. Neither scenario is ideal so improving strategies for diagnosis is imperative.
#41 Treatment and survival outcomes of lobular carcinoma in situ of the breast: a SEER population based study | Oncotarget
https://www.oncotarget.com/article/21461/text/
Treatment was an important predictor of OS, with patients underwent LRT and LA demonstrating better survival compared to those who accepted MRT. […] Age at diagnosis was another factor associated with better OS, which was characterized by the better prognosis of patients diagnosed with LCIS at age 40. […] In addition, it was revealed that poor prognostic significance was relevant to the black race. […] PR positive patients showed better OS than PR negative ones, while no significant effects on OS of ER status nor histopathological grade was observed. […] Despite the limitations listed above, to our knowledge, this is the first large population-based study to evaluate impacts of surgical and radiation intervention on survival outcomes of LCIS.
#42 LobSig is a multigene predictor of outcome in invasive lobular carcinoma | npj Breast Cancer
https://www.nature.com/articles/s41523-019-0113-y
The Genomic Grade Index (GGI/MapQuantDx) panel has been shown to be more powerful than grade alone in the ILC population, while MammaPrint has validated value only in node negative ILC patients. […] The clinical utility in ILC of the 21-gene signature, OncotypeDx, remains unclear with two studies showing classification of 42% and 35.5% of patients as being as of intermediate risk. […] LobSig is highly prognostic in unselected ILC, and specifically in grade 2 and grade 3 ILC tumors, as well as to a lesser degree in ER-positive, grade 2 IC-NST cases. […] LobSig outperforms existing signatures in both a univariate and multivariate context, and shows greater prognostic capability than the NPI. […] LobSig is particularly effective in grade 2 ILC tumors, versus all ILC. […] The data presented here supports that LobSig low-risk patients need not receive adjuvant chemotherapy. […] In conclusion, we present the molecular signature, LobSig, which captures the peculiar genomic landscape of ILC tumors, and together with clinico-pathology information, provides a robust mechanism for prognostication in ILC.