Prognostic Markers and Long-Term Outcomes in Ductal Carcinoma In Situ of the Breast Treated with Excision Alone
PJ Holmes, GF Schwartz, I Chervoneva, E Pequignot, J Lloyd, DB Cornfield, JP Palazzo. Thomas Jefferson University Hospital, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA; UPMC Presbyterian, Pittsburgh, PA; Health Network Laboratories, Allentown, PA
Background: With increases in breast cancer screening, the number of cases of Ductal Carcinoma in Situ (DCIS) has risen dramatically. However, there remains no definite way to predict recurrence of DCIS. This study analyzed the significance of biological markers and tumor subtypes in predicting recurrence in a large series of DCIS patients with long term follow-up treated with local breast conservation surgery alone.
Design: Clinical and pathologic data was analyzed from 211 patients who underwent local excision alone (with negative margins) for DCIS diagnosed between 1983 and 2002. Using local disease recurrence as an endpoint, the authors sought to determine the prognistic significance of several histopathologic characteristics (tumor size, necrosis, and subtype) and biologic markers (estrogen receptor [ER], progesterone receptor [PR], and Her-2/neu.)
Results: With a median follow up of 122 months (max 294 months), 73 recurrences occurred with a median follow up of 147 months and a median month to recurrence of 232. Recurrences occurred between 9 and 294 months after initial diagnosis. In a multivariate analysis tumor size and Her2 positivity (3+) were found to be significantly associated with tumor recurrence (95% CI, p=0.005 and p=0.012). Necrosis and nuclear grade were not found to be significantly related to time to disease recurrence. Tumor pathologic characteristics were not found to be significantly related to time to disease recurrence. 59 out of the 73 recurrences were DCIS. 12 out of the 73 recurrences were invasive. None of the subtypes or biologic markers (ER or PR) was found to be a significant predictor of invasive versus noninvasive recurrence.
Conclusions: The current results suggest that over the long-term, larger tumor size and Her-2 neu status are significantly correlated with time to recurrence in patients treated by surgery alone. Using traditional logistic analysis, no significant correlation was found between tumor pathologic characteristics and recurrence.
Monday, March 22, 2010 11:15 AM
Platform Session: Section C, Monday Morning