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

Yan Fang,Weiguo Chen,Li Zhu,Yafen Li,Xiaochun Fei,Ou Huang,Kunwei Shen,Xiaosong Chen,Jiayi Wu,Yu Zong,Wei Wang,Jianrong He

doi:10.18632/oncotarget.11639

Yan Fang, Weiguo Chen + Show 10 more

Open Access

https://doi.org/10.18632/oncotarget.11639

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Journal: Oncotarget	Publication Date: Aug 26, 2016
Citations: 47	License type: cc-by

Affiliation: Shanghai Jiao Tong University

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.

Highlights

Patients with human epidermal growth factor receptor2 (HER2)-positive DCISMi had a worse survival and adjuvant chemotherapy plus target therapy needs to be further optimized in those patients
According to the staging system of the American Joint Committee on Cancer (AJCC), ductal carcinoma in situ with microinvasion (DCIS-Mi) was defined as ductal carcinoma in situ (DCIS) with a microscopic focus of invasion ≤1 mm in the longest diameter [1], which is identified in 10–20% of DCIS cases and accounts for approximately 1% of all breast cancers [2, 3]
Ductal carcinoma in situ with microinvasion (DCIS-Mi) tumors tended to exhibit the highest proportion of human epidermal growth factor receptor2 (HER2)-positive tumor (29.5% for DCIS, 42.9% for DCIS-Mi and 29.3% for DCIS-T1a, P=0.048)

Summary

Introduction

According to the staging system of the American Joint Committee on Cancer (AJCC), ductal carcinoma in situ with microinvasion (DCIS-Mi) was defined as ductal carcinoma in situ (DCIS) with a microscopic focus of invasion ≤1 mm in the longest diameter [1], which is identified in 10–20% of DCIS cases and accounts for approximately 1% of all breast cancers [2, 3]. The natural history of cancer cells progression from DCIS to DCISMi, and to invasive ductal carcinoma (IDC) remains unclear, and DCIS-Mi may represent the interim stage in the evolutionary progress from DCIS to IDC. Ductal 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

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Conclusion