Evaluation of a Breast Cancer Nomogram for Predicting Risk of Ipsilateral Breast Tumor Recurrences in Patients With Ductal Carcinoma in Situ After Local Excision

Abstract

A B S T R A C T PurposePrediction of patients at highest risk for ipsilateral breast tumor recurrence (IBTR) after local excision of ductal carcinoma in situ (DCIS) remains a clinical concern. The aim of our study was to evaluate a published nomogram from Memorial Sloan-Kettering Cancer Center to predict for risk of IBTR in patients with DCIS from our institution. Patients and MethodsWe retrospectively identified 794 patients with a diagnosis of DCIS who had undergone local excision from 1990 through 2007 at the MD Anderson Cancer Center (MDACC). Clinicopathologic factors and the performance of the Memorial Sloan-Kettering Cancer Center nomogram for prediction of IBTR were assessed for 734 patients who had complete data. ResultsThere was a marked difference with respect to tumor grade, prevalence of necrosis, initial presentation, final margins, and receipt of endocrine therapy between the two cohorts. The biggest difference was that more patients received radiation in the MDACC cohort (75% at MDACC v 49% at MSKCC; P Ͻ .001). Follow-up time in the MDACC cohort was longer than in the MSKCC cohort (median 7.1 years v 5.6 years), and the recurrence rate was lower in the MDACC cohort (7.9% v 11%). The median 5-year probability of recurrence was 5%, and the median 10-year probability of recurrence was 7%. The nomogram for prediction of 5-and 10-year IBTR probabilities demonstrated imperfect calibration and discrimination, with a concordance index of 0.63. ConclusionPredictive models for IBTR in patients with DCIS who were treated with local excision are imperfect. Our current ability to accurately predict recurrence on the basis of clinical parameters alone is limited.

Outcomes for Women with Minimal-Volume Ductal Carcinoma In Situ Completely Excised at Core Biopsy

“…A publicly available risk-estimation model (at www.nomograms.org) has been validated in at least 5 independent patient populations, and provides an individualized risk estimate. 28–33 Risks and benefits of the various management options can then be weighed by the individual patient and her clinician, according to her values, with the goal of choosing the optimal treatment strategy.…”

Relationship Between Margin Width and Recurrence of Ductal Carcinoma In Situ

“…30–32 A nomogram that combines 10 different patient and pathological variables and adjuvant treatments to estimate risk of recurrence after BCS for DCIS allows identification of those at relatively low risk of recurrence 16 and has been validated in independent populations. 33–35 …”

Ductal carcinoma in situ of the breast: the importance of morphologic and molecular interactions

“…Nuclear grade and margin status are other factors that appear to influence recurrence in DCIS, though certainly there are studies that refute these findings [12]. Two major clinical tools that aid in risk stratification and treatment planning--the University of Southern California/Van Nuys Prognostic Index and the DCIS nomogram introduced by Rudloff et al--utilize both clinical and pathologic factors such as tumor size, necrosis, and margin status [10,13,14]. While our current ability to accurately predict recurrence on the basis of this parameters is limited, clearly the paradigm that "one approach fits all" in patients with DCIS is shifting.…”