Prognostic markers and long‐term outcomes in ductal carcinoma in situ of the breast treated with excision alone

• Published in: Cancer 2011-08, Vol.117 (16), p.3650-3657
• Main Authors: Holmes, Phoebe, Lloyd, Joshua, Chervoneva, Inna, Pequinot, Edward, Cornfield, Dennis B., Schwartz, Gordon F., Allen, Kathleen G., Palazzo, Juan P.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers, Tumor - analysis; breast conservation surgery; Carcinoma, Ductal, Breast - metabolism; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - surgery; ductal carcinoma in situ; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Prognosis; prognostic markers; Receptor, ErbB-2 - analysis; Treatment Outcome; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.25942

BACKGROUND: Increased use of breast cancer screening has led to an increase in the number of diagnosed cases of ductal carcinoma in situ (DCIS). However, there is no definite way to predict progression or recurrence of DCIS. We analyzed the significance of biological markers and tumor characteristics in predicting recurrence in a large series of DCIS patients with long‐term follow‐up treated with breast conservation surgery (BCS) alone. METHODS: Clinical and pathological data were analyzed for 141 patients who underwent BCS for DCIS. All had negative surgical margins. Using local disease recurrence as an endpoint, we sought to determine the prognostic significance of several histopathological characteristics (tumor size, presence of necrosis, and subtype) and biological markers (estrogen receptor, progesterone receptor, and Her‐2/neu.) RESULTS: At a median follow‐up of 122 months (maximum follow‐up, 294 months), 60 recurrences occurred, with a median time to recurrence of 191 months. On multivariate analysis, Her‐2 positivity (3+) was found to be significantly associated with reduced time to tumor recurrence (P = .028). Tumor size and higher grade were marginally statistically significant (P = .099, P = .070). Neither necrosis nor tumor pathological characteristics were found to be significantly related to time to disease recurrence. CONCLUSIONS: Our results suggested that status of Her‐2/neu, larger tumor size, and higher nuclear grade were significantly correlated with time to tumor recurrence in patients treated with BCS alone. Using logistical analyses, no significant correlation was found between tumor pathological characteristics and disease recurrence. Cancer 2011. © 2011 American Cancer Society. We conducted a single‐institution analysis of several cases of breast ductal carcinoma in situ (DCIS) in which patients were treated with breast conservation surgery alone and followed up for as many as 24 years. Morphological features and prognostic markers were analyzed to determine their significance for predicting time to recurrence of DCIS.