Overall survival is improved when DCIS accompanies invasive breast cancer

Adam J Kole,Abhijit A Patel,Skyler B Johnson,Jacqueline R Kelly,Henry S Park,Meena S Moran

doi:10.1038/s41598-019-46309-2

Adam J Kole, Abhijit A Patel + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-46309-2

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Abstract

Invasive ductal carcinoma (IDC) often presents alone or with a co-existing ductal carcinoma in situ component (IDC + DCIS). Studies have suggested that pure IDC may exhibit different biological behavior than IDC + DCIS, but whether this translates to a difference in outcomes is unclear. Here, utilizing the National Cancer Database we identified 494,801 stage I-III breast cancer patients diagnosed with either IDC alone or IDC + DCIS. We found that IDC + DCIS was associated with significantly better overall survival (OS) compared to IDC alone (5-year OS, 89.3% vs. 85.5%, p < 0.001), and this finding persisted on multivariable Cox modeling adjusting for demographic, clinical, and treatment-related variables. The significantly superior OS observed for IDC + DCIS was limited to patients with invasive tumor size < 4 cm or with node negative disease. A greater improvement in OS was observed for tumors containing ≥25% DCIS component. We also found IDC + DCIS to be associated with lower T/N stage, low/intermediate grade, ER/PR positivity, and receipt of mastectomy. Thus, the presence of a DCIS component in patients with IDC is associated with favorable clinical characteristics and independently predicts improved OS. IDC + DCIS could be a useful prognostic factor for patients with breast cancer, particularly if treatment de-escalation is being considered for small or node negative tumors.

Highlights

Ductal carcinoma in situ (DCIS) is an established precursor to invasive breast cancer and often co-exists pathologically with invasive ductal carcinoma (IDC)[1,2,3]
Prior studies have demonstrated that Invasive ductal carcinoma (IDC) + DCIS tumors are associated with favorable clinical characteristics such as smaller tumor size, lower tumor grade, lower Ki-67 staining, greater estrogen receptor (ER)-positivity, and reduced risk of local recurrence when compared to IDC alone[5,6,7,8,9]
We identified a total of 494,801 stage I-III breast cancer patients with either IDC alone or IDC + DCIS who met study inclusion criteria (Fig. 1)

Summary

Introduction

Ductal carcinoma in situ (DCIS) is an established precursor to invasive breast cancer and often co-exists pathologically with invasive ductal carcinoma (IDC)[1,2,3]. Treatment paradigms for such cases of IDC with a DCIS component (IDC + DCIS) are similar to those for pure IDC alone, with the extent and characteristics of invasive disease driving clinical decisions[4]. It remains unclear, whether survival outcomes are similar for IDC when it presents alone or is accompanied by co-existing DCIS. The large sample size enabled us to investigate whether the effect of DCIS on survival differed when patients were categorized by the size of their invasive tumor component, nodal stage, or extent of the DCIS component

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