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As a result, there is limited research on prognosis and prognostic factors in young women with ILC. Here we set out to determine the long-term outcome and prognostic factors of women under 40\u2009years of age with lymph node-negative (N0), hormone-receptor positive (HR+)\/human epidermal growth-factor receptor 2 negative (HER2-) ILC who did not receive adjuvant systemic treatment (chemo- and\/or endocrine therapy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Through the Netherlands Cancer Registry we selected all systemically untreated patients younger than 40\u2009years with HR+\/HER2-, N0, early breast cancer diagnosed in the Netherlands from 1989-2000. At the time, node-negativity was considered a favorable prognostic marker and guidelines recommended no adjuvant systemic therapy for this subgroup. Distant recurrence-free survival (DRFS), recurrence-free survival (RFS) and overall survival (OS) were assessed according to the STEEP criteria. Uni- and multivariable Cox proportional hazard models were used to assess prognosis, calculating hazard ratios (HR) with confidence interval (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091138 selected patients,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200995 were histologically classified as ILC and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009805 as invasive breast cancer of no special type (BC-NST),\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009238 were classified as other breast cancer subtype. In ILC, tumor grade was not associated with DRFS\/RFS or OS (HR for DRFS 1.40, 95%CI 0.42\u20134.63). However, the presence of lymphovascular invasion (LVI) (adjusted HR DRFS 2.81, 95%CI 1.14\u20136.94,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and multifocality (adjusted HR DRFS 3.28, 95%CI 1.49\u20137.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) were. When comparing DRFS, RFS and OS in matched low-risk luminal A-like ILC vs. BC-NST, we observed a trend for worse 15-year survival in ILC (15-year DRFS 63% in ILC vs. 74% in BC-NST; HR 1.50, 95%CI 0.98\u20132.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In these young patients with systemically untreated N0 ILC we show that grade was not prognostic at 15\u2009years follow-up, whereas LVI and multifocality were. Furthermore, ILC had a numerically worse 15-year survival than matched luminal A-like BC-NST.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-08024-1","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:46:03Z","timestamp":1785991563000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Invasive lobular breast cancer in young patients without adjuvant systemic treatment: 15-year survival outcomes"],"prefix":"10.1007","volume":"218","author":[{"given":"R. A. B.","family":"Voorthuis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Opdam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. 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