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

Abstract

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.

Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ – The LORD study

“…We have re-formulated the design assumptions based on 5-year iiBC-free%, presuming a fairly constant event rate over time [33][34][35][36][37][38][51][52][53][54][55][56][57][58]. We have assumed that the mastectomy rate in the standard treatment arm is 20% and that the 5-year iiBC-free% equals 100% for this treatment.…”

Progression of ductal carcinoma in situ to invasive breast cancer is associated with gene expression programs of EMT and myoepithelia

“…Nuclear grade, the presence of necrosis, and size of the lesion have all been linked to increased risk of DCIS recurrence [3,4]. In addition, numerous biomarkers have been investigated for better risk stratification of patients with DCIS.…”

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky

“…Prognostic and predictive factors that are measured for DCIS include nuclear grade, histology, size, and estrogen receptor status. 10 Many of these factors also influence the risk of a DCIS lesion containing or bordering an area of invasive cancer.…”