Abstract
To investigate the clinicopathological characteristics and survival outcomes of microinvasive breast cancer, we conducted an observational study of female diagnosed with DCIS or DCIS with microinvasion (DCISM) from 1990 to 2012 using the Surveillance, Epidemiology, and End Results (SEER) database. There were 87695 DCIS and 8863 DCISM identified. In DCISM group, patients appeared to be younger and more black patients were identified in comparison with DCIS group. Furthermore, DCISM was associated with more aggressive tumor characteristics like higher rates of oestrogen receptor (ER) and progesterone receptor (PR) negativity, HER2 positivity, and lymph node metastasis. With a median follow-up of 91 months, patients with DCISM had worse cancer-specific survival (CSS) (hazard ratio [HR], 2.475; P < 0.001) and overall survival (OS) (HR, 1.263; P < 0.001). In the multivariable analysis, microinvasion was an independent prognostic factor for worse CSS (HR, 1.919; P < 0.001) and OS (HR, 1.184; P < 0.001). The 10-year cancer-specific mortality rate was 1.49% in DCIS and 4.08% in DCISM (HR, 2.771; P < 0.001). The 20-year cancer-specific mortality rate was 4.00% in DCIS and 9.65% in DCISM (HR, 2.482; P < 0.001). Deepening understanding of the nature of microinvasive breast cancer will be valuable for clinical treatment recommendations.
Highlights
Ductal carcinoma in situ with microinvasion (DCISM) is an uncommon pathologic entity accounting for approximately 1% of all breast cancer cases[6]
DCIS with microinvasion (DCISM) was associated with more aggressive tumor characteristics like estrogen receptor (ER) negative (33.1% vs. 17.5%; P < 0.001), progesterone receptor (PR) negative (44.9% vs. 27.3%; P < 0.001), HER2 positive (36.5% vs. 32.4%; P = 0.009) and lymph node metastasis (7.6% vs. 0%; P < 0.001)
Microinvasive carcinoma is rare and there are controversial results reported on the survival outcomes of this special breast cancer subtype compared with those of DCIS12–17
Summary
Ductal carcinoma in situ with microinvasion (DCISM) is an uncommon pathologic entity accounting for approximately 1% of all breast cancer cases[6]. The relative rarity and inconsistent definitions for microinvasion have contributed to the confusion regarding this entity. Several recent studies reported on the histopathologic findings and clinical outcomes of DCISM9–13, it remains controversial whether the biologic behavior and survival outcomes of this special breast cancer subtype are distinct from those of DCIS. Further evaluation on the impact of microinvasion on survival is essential to defining the treatment recommendations and prognosis. A population-based study was designed to assess the differences in clinicopathologic characteristics and long-term outcomes between DCIS and DCISM using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database
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