Abstract
PurposeBetter tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone.MethodsData from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis.ResultsThe combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone.ConclusionsThe combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.
Highlights
Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer but some women will go on and develop invasive breast cancer [1]
To assess and compare the clinical utility of each model (DS alone, tumor size and age at diagnosis alone or integration of all three parameters combined), we examined its ability to identify patients with a low estimated 10-year risk of local recurrence (LR) and its ability to identify those with an estimated higher risk of LR after treatment by breast-conserving surgery (BCS) alone
We found that integrating the effects of the DCIS score (DS), tumor size and age at diagnosis identified a greater proportion of cases with a low risk of LR compared to models based on the DS alone, or one based solely on tumor size and age at diagnosis alone
Summary
Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer but some women will go on and develop invasive breast cancer [1]. Extended author information available on the last page of the article breast-conserving surgery (BCS) followed by the administration of whole breast radiotherapy (RT), which has been proven to lower the risk of local recurrence (LR) (DCIS or invasive) after BCS [2]. Some women will derive no or a very small absolute benefit from RT, resulting in unnecessary exposure to radiation and its potential toxicities (over-treatment), while in others the omission of RT may result in a higher risk of LR (and invasive LR) that might have been avoided by treatment (under-treatment) [3]. To reduce over-treatment and under-treatment of DCIS, ascertainment of more precise estimates of individualized LR risk after BCS is desirable to help clinicians and patients more accurately assess the risks of LR with the potential absolute benefits of treatment
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