A single-center prognotic analysis of breast ductal carcinoma in situ

doi:10.19401/j.cnki.1007-3639.2022.03.005

Abstract

Abstract:

Background and purpose: The incidence of ductal carcinoma in situ (DCIS) has increased annually with the popularity of mammography screening. However, current treatment strategies are mostly based on the results of prospective randomized clinical trials in western countries. This study aimed to explore the clinical characteristics, recurrence patterns and prognostic factors of Chinese DCIS patients, hoping to optimize clinical decision-making. Methods: Medical records of 1 185 DCIS patients treated in Fudan University Shanghai Cancer Center from January 2008 to January 2017 were retrospectively analyzed. The local recurrence-free survival (LRFS) rate, disease-free survival (DFS) rate and overall survival (OS) rate were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the COX proportional hazards regression model. Results: With a median follow-up of 61 months, 50 treatment failure events were observed, including 16 locoregional recurrences, 30 contralateral breast cancer events and 4 distant metastases. The 5-year OS rate, LRFS rate and DFS rate were 99.9%, 98.7% and 96.6%, respectively. In the multivariate analysis, the positive status of human epidermal growth factor receptor 2 (HER2) was related to higher risk of local recurrence and the LRFS rate was poor (P=0.029). Conclusion: The patient with DCIS was associated with favorable prognosis. HER2 positivity was the risk factor for poor LRFS.

Key words: Ductal carcinoma in situ, Breast cancer, Prognosis

CLC Number:

R737.9

YANG Yilan, ZHAO Xu, CHEN Xingxing, WANG Xuanyi, JIN Kairui, ZHANG Zhen, SHAO Zhimin, GUO Xiaomao, YU Xiaoli. A single-center prognotic analysis of breast ductal carcinoma in situ[J]. China Oncology, 2022, 32(3): 228-233.

Figures/Tables 5

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References 16

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Characteristic	Case (N=1 185)	Characteristic	Case (N=1 185)
Age/year		Negative	225 (19.0)
≤40	201 (17.0)	Positive	960 (81.0)
41-60	750 (63.3)	HER2 status
>60	234 (19.7)	Negative	585 (49.4)
Menopausal status		Positive	274 (23.1)
Premenopausal	658 (55.5)	Unknown	326 (27.5)
Postmenopausal	514 (43.4)	Breast and axillary surgery
Unknown	13 (1.1)	Lumpectomy	133 (11.2)
Family history of malignant tumors		BCS+SLNB	146 (12.3)
No	821 (69.3)	BCS+ALND	10 (0.8)
Yes	364 (30.7)	Mastectomy	81 (6.8)
Tumor size D/cm		Mastectomy+SLNB	610 (51.5)
≤2.5	919 (77.6)	Mastectomy+ALND	205 (17.3)
>2.5	165 (13.9)	Reconstructive surgery
Unknown	101 (8.5)	No	1 086 (91.6)
Nuclear grade		Yes	99 (8.4)
Low	300 (25.3)	Radiotherapy
Intermediate	548 (46.2)	No	957 (80.8)
High	286 (24.1)	Yes	218 (18.4)
Unknown	51 (4.3)	Unknown	10 (0.8)
Margins		Hormone therapy
Negative (≥2 mm)	1 174 (99.1)	No	510 (43.0)
Positive (<2 mm)	11 (0.9)	Yes	659 (55.6)
HR status		Unknown	16 (1.4)

Patterns of treatment failure	Case n
Locoregional recurrence
Local recurrence
Breast	11
Chest wall	2
Regional recurrence
Lymph nodes in the axillary area	1
Lymph nodes in the collarbone area	2
Contralateral breast cancer
Carcinoma in situ	18
Invasive carcinoma	12
Distant metastasis	4

Variable	LRFS			DFS
Variable	HR	95% CI	P value	HR	95% CI	P value
Age/year
41-60 vs ≤40	0.4	0.1-1.0	0.054	0.7	0.3-1.3	0.221
>60 vs ≤40	0.3	0.1-1.4	0.131	0.6	0.2-1.4	0.235
Menopausal status (postmenopausal vs premenopausal)	0.3	0.1-1.0	0.058	0.7	0.4-1.3	0.282
Family history of malignant tumors (yes vs no)	1.3	0.5-3.5	0.632	1.5	0.9-2.7	0.129
Tumor size D/cm（>2.5 vs ≤2.5）	1.4	0.4-4.7	0.639	0.8	0.3-2.0	0.578
Nuclear grade
Low	No event	No event	No event	1.0	Reference	Reference
Intermediate	1.3	0.4-4.1	0.656	1.2	0.6-2.5	0.604
High	1.0	Reference	Reference	1.2	0.5-2.8	0.616
Margins (positive vs negative)	No event	No event	No event	2.3	0.3-16.7	0.409
HR status (positive vs negative)	0.4	0.2-1.3	0.124	0.9	0.4-1.8	0.737
HER2 status (positive vs negative)	2.7	0.8-8.9	0.098	1.3	0.7-2.6	0.399
Local treatment (mastectomy vs BCS + radiotherapy)	0.4	0.1-1.1	0.086	1.0	0.5-1.9	0.883
Reconstructive surgery (yes vs no)	0.8	0.1-6.1	0.835	1.6	0.7-3.8	0.265
Hormone therapy (yes vs no)	0.7	0.3-2.0	0.566	0.7	0.4-1.2	0.205
Chemotherapy (yes vs no)	2.4	0.6-10.7	0.242	1.3	0.5-3.6	0.624

Variable	LRFS
Variable	HR	95% CI	P value
Age/year
41-60 vs ≤40	0.5	0.1-2.2	0.349
>60 vs ≤40	1.5	0.1-15.5	0.754
Menopausal status (postmenopausal vs premenopausal)	0.4	0.1-2.3	0.295
HER2 status (positive vs negative)	4.2	1.2-15.5	0.029^*
Local treatment (mastectomy vs BCS + radiotherapy)	0.4	0.1-1.4	0.146