Biologic behavior and long-term outcomes of breast ductal carcinoma in situ with microinvasion

Abstract

BackgroundDuctal carcinoma in situ with microinvasion (DCIS-Mi) generally has favorable prognosis, but the long-term outcomes of DCIS-Mi and the biologic evolution from ductal carcinoma in situ (DCIS), DCIS-Mi, to DCIS with T1a breast cancer (DCIS-T1a) has not been specified. The aim of our study was to explore the biological and prognostic features of DCIS-Mi, compared with pure DCIS and DCIS-T1a.ResultsAfter a median follow-up of 31 months, the 3-year estimated disease free survival(DFS) rate of DCIS-Mi patients was significantly lower than that of pure DCIS patients (89.5% vs 97.1%, P=0.009). Patients with DCIS-Mi or DCIS-T1a tumors had comparable 3-year estimated DFS rates (89.5% vs 94.3%, P=0.13). No significant difference in overall survival (OS) was found among different groups (99.6%, 100% and 99.1% for DCIS, DCIS-Mi and DCIS-T1a, P=0.797). In chemotherapy and trastuzumab-naive DCIS-Mi patients, human epidermal growth factor receptor2 (HER2) positivity (HR=21.8, 95%CI, 1.7-286.8, P=0.019) were independent predictor of worse DFS on multivariate analysis.MethodsDuring September 2002 and December 2014, 602 breast cancer patients who underwent radical surgery were retrospectively reviewed. Three hundred and fifty-nine patients (59.6%) had pure DCIS, 84(14.0%) and 159(26.4%) were diagnosed as DCIS-Mi and DCIS-T1a. Clinico-pathological features were compared between different subgroups.ConclusionsDCIS-Mi displayed a comparable survival to that of DCIS-T1a and a more aggressive biological nature than pure DCIS. Patients with HER2-positive DCIS-Mi had a worse survival and adjuvant chemotherapy plus target therapy needs to be further optimized in those patients.

Epithelial‐mesenchymal transition inducer Snail1 and invasive potential of intraductal breast cancer

“…In 57% of DCIS with microinvasion an appearance of a mass is common, irrespective of lesion size, mimicking findings seen in invasive cancer . DCIS with microinvasion (DCIS‐T1mic) is considered the interim stage in the evolutionary progress from DCIS to invasive tumor . However, it remains unclear, if it is biologically more similar to pure DCIS or to small infiltrating cancer with an intraductal component (DCIS‐T1a).…”

“…However, it remains unclear, if it is biologically more similar to pure DCIS or to small infiltrating cancer with an intraductal component (DCIS‐T1a). When compared with pure DCIS, DCIS‐T1mic is significantly more often of high nuclear grade, comedonecrosis is more common, hormone receptors‐negative and HER2‐positive tumors are more frequent . Fang et al observed that with the procedure of invasion (pure DCIS vs DCIS‐T1mic vs DCIS‐T1a), the proportion of luminal‐like subtype was significantly decreasing, whereas basal‐like subtype was increasing.…”

“…Meta‐analysis by Gojon and co‐workers (24 studies including 968 patients) demonstrated the nodal positivity in microinvasive cancer for macrometastasis, micrometastasis, and isolated tumor cells in 3.2%, 4.0%, and 2.9% of patients, respectively . Despite those low rates, indications for sentinel node biopsy in DCIS‐T1mic seem to be sometimes justified, because in some cases this risk can be considerably higher, for example, up to 15.6% in patients with multiple foci of microinvasion within DCIS . Therefore, the decision should be individualized .…”

“…Li et al did not find a significant difference in the overall survival rate between patients with pure DCIS and DCIS‐T1mic during median 100 months follow‐up. Fang et al reported that after a median follow‐up of 31 months no significant difference in 3‐year overall survival rates was found among pure DCIS, DCIS‐T1mic, and DCIS‐T1a. However, disease‐free survival rate of DCIS‐T1mic patients was significantly lower than that in pure DCIS group and comparable with DCIS‐T1a patients.…”

“…14 (21) 3 (strong) 29 (14) high nuclear grade, 15,16 comedonecrosis is more common, [15][16][17] hormone receptors-negative and HER2-positive tumors are more frequent. 16,17 Fang et al 15 15 Therefore, the decision should be individualized. 18 Since the prognosis in DCIS is generally favorable, the potential impact of microinvasion on long-term survival remains a subject of debate.…”