Abstract
Purpose
To identify whether a certain group of breast ductal carcinoma-in-situ (DCIS) patients
can be treated with breast-conserving surgery (BCS) alone; to analyze the clinicopathologic
features of DCIS and tamoxifen administration in patients treated with BCS who developed
ipsilateral breast tumor recurrence (IBTR).
Patients and Methods
Data for 375 women with breast DCIS who underwent BCS at our institute between June
2003 and October 2010 were analyzed. The patients were divided into different categories
according to the recurrence risk predicted using the California/Van Nuys Prognostic
Index (USC/VNPI) score (4-6, 7-9, and 10-12), Eastern Cooperative Oncology Group (ECOG)
E5194 criteria, or combined risk features with USC/VNPI score and ECOG E5194 criteria.
The IBTR and disease-free survival (DFS) rates were calculated by the Kaplan-Meier
method. The prognostic effects of age, tumor size, tumor grade, margin width, estrogen
receptor status, USC/VNPI score, low-risk characteristics, and tamoxifen use were
evaluated by log-rank tests.
Results
Of the patients, 168 were treated with breast irradiation after BCS and 207 were not.
The patients who were treated with radiotherapy (RT) tended to be younger (< 40 years),
to have higher USC/VNPI scores (7-9), and to meet the ECOG E5194 non–cohort 1 criteria.
The 7-year risk of IBTR was 6.2% (n = 11) in the patients who received irradiation
and 9.0% (n = 22) in those who did not. DFS rates were better in the patients who
underwent RT than in those who did not (93.3% vs. 88.5%, P = .056). Among the patients who underwent BCS alone, age ≥ 40 years, margin width
> 10 mm, USC/VNPI scores 4-6, ECOG E5194 cohort 1 criteria, estrogen receptor–positive
status, and tamoxifen use predicted lower IBTR and better DFS rates. In the multivariate
analysis, combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG
E5194 cohort 1 criteria) were identified as an independent prognostic factor of lower
IBTR (P = .028) and better DFS (P = .005).
Conclusion
RT reduces the risk of IBTR after BCS for DCIS of the breast. Patients with combined
low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1
criteria) may be adequately treated with BCS alone.
Keywords
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Article info
Publication history
Published online: April 09, 2018
Accepted:
April 2,
2018
Received in revised form:
March 23,
2018
Received:
August 1,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
