Data from Prognostic Value of ER and PgR Expression and the Impact of Multi-clonal Expression for Recurrence in Ductal Carcinoma <i>in situ</i>: Results from the UK/ANZ DCIS Trial

Abstract

<div>AbstractPurpose:<p>The prognostic value of estrogen receptor (ER)/progesterone receptor (PgR) expression in ductal carcinoma <i>in situ</i> (DCIS) is unclear. We observed multi-clonality when evaluating ER/PgR expression in the UK/ANZ DCIS trial, therefore, we investigated the prognostic role of both uni-clonal and multi-clonal ER/PgR expression in DCIS.</p>Experimental Design:<p>Formalin-fixed paraffin embedded tissues were collected from UK/ANZ DCIS trial participants (<i>n</i> = 755), and ER/PgR expression was evaluated by IHC in 181 cases (with recurrence) matched to 362 controls by treatment arm and age. Assays were scored by the Allred method and by a newly devised clonal method—analyses categorizing multi-clonal DCIS as ER/PgR-positive as per current practice (Standard) and as ER/PgR-negative (clonal) were performed.</p>Results:<p>ER expression was multi-clonal in 11% (39/356) of ER-positive (70.6%, 356/504) patients. Ipsilateral breast event (IBE) risk was similarly higher in ER-multi-clonal and ER-negative DCIS as compared with DCIS with uni-clonal ER expression. ER-negative DCIS (clonal) had a higher risk of <i>in situ</i> IBE [OR 4.99; 95% confidence interval (CI), 2.66–9.36; <i>P</i> < 0.0001], but the risk of invasive IBE was not significantly higher (OR 1.72; 95% CI, 0.84–3.53; <i>P</i> = 0.14), <i>P</i><sub>heterogeneity</sub> = 0.03. ER was an independent predictor in multivariate analyses (OR 2.66; 95% CI, 1.53–4.61). PgR status did not add to the prognostic information provided by ER.</p>Conclusions:<p>ER expression is a strong predictor of ipsilateral recurrence risk in DCIS. ER-positive DCIS with distinct ER-negative clones has a recurrence risk similar to ER-negative DCIS. ER should be routinely assessed in DCIS, and ER scoring should take clonality of expression into account.</p></div>