Ductal carcinoma in situ of the breast results of conservative and radical treatments in 716 patients

Cutuli, B.; Nir, C. Cohen-Solal-Le; Lafontan, B. De; Mignotte, H.; Fichet, V.; Fay, Renaud; Servent, V.; Giard, S.; Charra-Brunaud, C.; Auvray, H.; Penault‐Llorca, Frédérique; Charpentier, Jean-Christophe

doi:10.1016/s0959-8049(01)00303-3

Cited by 59 publications

(41 citation statements)

References 28 publications

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“…238,239 The presence of these cells is associated with higher risk of recurrence. 237,[240][241][242][243][244] The long intervals between primary tumors and their recurrences suggest that tumor cells may have developed mechanisms that allow for their long-term survival in a dormant state. Indeed, disseminated cancer cells may face nutrient starvation and may readjust their metabolic programs to allow them to use alternative energy sources during their dormant period.…”

Section: Quiescence In Dormant Cancer Cellsmentioning

confidence: 99%

Staying alive

et al. 2012

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Ensuring the continuity of life requires that individual cells and entire organisms can survive not only in ideal environments, but also in conditions of scarcity. When conditions are unfavorable for proliferation, many cells have the capacity to enter a nondividing state, sometimes for years, while retaining their ability to reenter the proliferative cell cycle. 1,2 This state of reversible cell cycle arrest, known as quiescence, is common and can be seen in stem cells, eggs and spores. Some quiescent cells are surprisingly hardy: they can survive long periods of nutrient starvation, cold temperatures and even desiccation. Entry into quiescence is often associated with dramatic changes in metabolism, defined as the uptake of nutrients and the use of these nutrients for the synthesis of macromolecules and energy. Indeed, proliferating and quiescent fibroblasts are expected to have very different metabolic requirements. While proliferating cells must devote much of their metabolic capacity to biosynthesis in order to create the material necessary to form a new cell, quiescent cells are relieved of this steep metabolic requirement. Many but not all quiescent cells respond by downregulating the synthesis of proteins *Correspondence to: Hilary Coller; Email: hcoller@princeton.edu Submitted: 02/22/12; Accepted: 02/27/12 http://dx.doi.org/10. 4161/cc.19879 Quiescence is a state of reversible cell cycle arrest that can grant protection against many environmental insults. in some systems, cellular quiescence is associated with a low metabolic state characterized by a decrease in glucose uptake and glycolysis, reduced translation rates and activation of autophagy as a means to provide nutrients for survival. For cells in multiple different quiescence model systems, including Saccharomyces cerevisiae, mammalian lymphocytes and hematopoietic stem cells, the Pi3Kinase/TOr signaling pathway helps to integrate information about nutrient availability with cell growth rates. Quiescence signals often inactivate the TOr kinase, resulting in reduced cell growth and biosynthesis. However, quiescence is not always associated with reduced metabolism; it is also possible to achieve a state of cellular quiescence in which glucose uptake, glycolysis and flux through central carbon metabolism are not reduced. in this review, we compare and contrast the metabolic changes that occur with quiescence in different model systems. 2 The signals for quiescence vary for different types of cells. Bacteria and yeast can enter stationary phase, a condition in which they cease cell growth and proliferation, in response to depletion of the glucose in their culture medium or in response to deprivation for a specific nutrient. In mammals, the proliferative state of individual cells is regulated by a host of factors that include not only the presence or absence of nutrients, but also cues from proliferative signaling molecules such as mitogens and situational cues. Quiescent T lymphocytes respond to stimulation of their T-cell receptor with the approp...

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Section: Quiescence In Dormant Cancer Cellsmentioning

confidence: 99%

Staying alive

et al. 2012

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“…Compared to those without postoperative mammogram, Vargas et al found that women with postoperative mammogram have lower IBTR (HR = 0.21 with P-value = 0.04) [58]. Method of detection Three RCTs and nine observational studies examined the association between method of detection and outcome [15,17,21,26,28,30,34,35,[44][45][46]56]. We excluded one observational study because its relative risk estimate was not reported [56].…”

Section: Marginsmentioning

confidence: 99%

Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

Wang

Shamliyan

Virnig

et al. 2011

Breast Cancer Res Treat

135

106

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While ductal carcinoma in situ (DCIS) is seldom life threatening, the management of DCIS remains a dilemma for patients and their physicians. Aggressive treatment reduces the risk of ipsilateral breast tumor recurrence (IBTR), but has never been proven to improve survival. There is interest in identifying the prognostic factors for determining low-risk DCIS patients, but a comprehensive review of high-quality evidence on tumor characteristics in predicting local recurrence has never been carried out. We examined the following tumor characteristics: biomarkers, comedonecrosis, focality, surgical margin, method of detection, tumor grade, and tumor size. For this systematic review we restricted the analyses to the results of subgroup analyses from randomized controlled trials (RCTs) and multivariate analyses from RCTs and observational studies. We identified 44 eligible articles. The pooled random-effects risk estimates for IBTR are comedonecrosis 1.71(95% CI, 1.36-2.16), focality 1.95(95% CI, 1.59-2.40), margin 2.25(95% CI, 1.77-2.86), method of detection 1.35(95% CI, 1.12-1.62), tumor grade 1.81(95% CI, 1.53-2.13), and tumor size 1.63(95% CI, 1.30-2.06). Limited evidence indicated that women whose DCIS is ER-negative, PR-negative, or HER2/neu receptor positive have an IBTR higher than those whose DCIS is ER-positive, PR-positive, and HER2/neu receptor negative. A variety of tumor characteristics are significant predictors for IBTR. These results are important for both clinicians and patients to interpret the risk of local recurrence and to decide on a course of treatment.

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“…3,5,6 In the not too distant past, the standard treatment for DCIS was mastectomy and complete axillary dissection, which eradicated the disease, but at the high cost of disfiguring surgery. 4,7,8 Local excision largely replaced this radical approach, and today lumpectomy is the standard of care for the majority of patients with DCIS. [9][10][11] Early experience…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24

Allred

Anderson

Paik

et al. 2012

JCO

313

184

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A B S T R A C T PurposeThe NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen. Patients and MethodsEstrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n ϭ 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n ϭ 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years). ResultsER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P Ͻ .001) and overall follow-up (HR, 0.60; P ϭ .003), which remained significant in multivariable analysis (overall HR, 0.64; P ϭ .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone. ConclusionPatients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.

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Ductal carcinoma in situ of the breast results of conservative and radical treatments in 716 patients

Cited by 59 publications

References 28 publications

Staying alive

Staying alive

Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24

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