Impact of Age on Locoregional and Distant Recurrence After Mastectomy for Ductal Carcinoma In Situ With or Without Microinvasion

Mamtani, Anita; Nakhlis, Faina; Downs-Canner, Stephanie; Zabor, Emily C.; Morrow, Monica; King, Tari A.; Zee, Kimberly J. Van

doi:10.1245/s10434-019-07693-1

Cited by 27 publications

(23 citation statements)

References 23 publications

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“…In our cohort, close margins are associated with a 16% increase in probability of LR regardless of biomolecular profile. Conversely to other studies we found no statistically significant association between LR and patients' age at diagnosis [20]. Aside from margin status, another possible predictor of LR is the type of surgery performed, although we did not find an association between surgery type and LR risk.…”

Section: Discussioncontrasting

confidence: 99%

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The Role of Margin Status on Local Recurrence in Microinvasive Ductal Carcinoma of the Breast

Grendele¹,

Pellegrini²,

Melina³

et al. 2021

SCR

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Microinvasive ductal carcinoma (MIDC) is an infrequent disease that accounts for about 1% of all breast cancer cases. Controversy on the management is related to the limited information available regarding lymph node involvement, recurrence rate and prognosis of the disease. In this retrospective single-center study, we included all patients diagnosed with MIDC at S. Orsola Malpighi Hospital in Bologna from 2011 to 2020. Demographic and clinicopathologic characteristics were collected and analysed. Furthermore, we analysed the factors related to local recurrence using univariate and multivariate analyses. We identified 57 patients diagnosed with MIDC. The median age at diagnosis was 56. Nuclear grade of the invasive foci was high in 44% of the patients. Estrogen receptors were found to be positive in 40% of patients, HER2 was overexpressed in 35% and 40% of patients had a high proliferation rate. Margin status was negative in 72% of the patients while close in 16 patients. 26 patients received breast conserving surgery (BCS) and 31 underwent mastectomy. Nodal staging with sentinel lymph node biopsy was performed in 82% of cases. In 96% were found negative sentinel lymph node. 92% of patients receiving BCS were treated with combined radiotherapy. 32% were treated with adjuvant endocrine therapy and 28% were given adjuvant chemotherapy. At a median follow-up of 42 months, we had no axillary recurrence, but 3 patients (5%) had local recurrence. In the multivariate analysis close margins are associated with a 16% increase in local recurrence. Results from this study show that sentinel lymph node biopsy could not be useful in MIDC according to the low risk of lymph node metastasis. The rate of local recurrence was 5% and our findings suggested a possible role of margin status in the development of local recurrence.

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Section: Discussioncontrasting

confidence: 99%

“…In consistence with rates reported in literature, we had a LR rate of 5% [9,14,20]. Our findings indicated a possible role of margin status in the development of LR.…”

Section: Discussionsupporting

confidence: 90%

The Role of Margin Status on Local Recurrence in Microinvasive Ductal Carcinoma of the Breast

Grendele¹,

Pellegrini²,

Melina³

et al. 2021

SCR

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“…Young age is a known risk factor for locoregional recurrence (LRR) following both BCS and mastectomy for DCIS. In a contemporary cohort of patients treated with mastectomy for DCIS ± microinvasion, the cumulative 10-year incidence of LRR was 4.2% for patients age < 40 years, 2.0% for age 40–49 and 0.2% for age ≥ 50 years ( p < 0.001) [ 6 ]. Similarly, in the setting of BCS, Cronin et al reported that LRR risk decreased with age, in patients who did and did not receive radiation [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

Pawloski

Tadros

Sevilimedu

et al. 2021

Breast Cancer Res Treat

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Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

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“…The prognostic factors described in this study were basically consistent with ndings of previous studies. Younger age, lymph node metastasis, multifocality, positive hormone receptor status have all previously been shown to be of signi cant relevance to the prognosis of DCISM patients [18,[26][27][28]. Excluding the therapeutic factors, AJCC 6th edition N stage contributes the most to the nal risk score (Figure 2), with clear distinctions between two adjacent N stages.…”

Section: Discussionmentioning

confidence: 95%

A Nomogram Predicting Survival in Patients with Breast Ductal Carcinoma in Situ with Microinvasion

Zheng

Qin²,

Li³

et al. 2021

Preprint

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Background: Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS).Methods: Women diagnosed with DCISM were selected from the Surveillance, Epidemiology and End Results database (1998-2015). Clinical variables and tumor characteristics were evaluated and Cox proportional-hazards regression model was performed. A nomogram was constructed from the multivariate logistic regression model to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years. Results: We identified 5,438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988-2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery (all P < 0.05). The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65) demonstrated excellent reliability and robust performance.Conclusion: Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up.

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Impact of Age on Locoregional and Distant Recurrence After Mastectomy for Ductal Carcinoma In Situ With or Without Microinvasion

Cited by 27 publications

References 23 publications

The Role of Margin Status on Local Recurrence in Microinvasive Ductal Carcinoma of the Breast

The Role of Margin Status on Local Recurrence in Microinvasive Ductal Carcinoma of the Breast

Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

A Nomogram Predicting Survival in Patients with Breast Ductal Carcinoma in Situ with Microinvasion

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