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Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ.

de Roos MA, de Bock GH, Baas PC, de Munck L, Wiggers T, de Vries J - Br. J. Cancer (2005)

Bottom Line: Positive margins were associated with LR (hazard ratio (HR)=4.790, 95% confidence interval (CI) 1.696-13.531).Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR=1.254, 95% CI 0.272-5.776 for time period 1992-1995 and HR=1.976, 95% CI 0.526-7.421 for time period 1996-1999).Compliance with the guidelines was an independent predictor of disease-free survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands. mderoos@tiscali.nl

ABSTRACT
The aim was to study the effect of compliance with guidelines on local recurrence (LR)-free survival in patients treated for ductal carcinoma in situ (DCIS). From January 1992 to December 2003, 251 consecutive patients had been treated for DCIS in two hospitals in the North Netherlands. Every case in this two-hospital sample was reviewed in retrospect for its clinical and pathological parameters. It was determined whether treatment had been carried out according to clinical guidelines, and outcomes in follow-up were assessed. In addition, all patients treated for DCIS in this region (n=1389) were studied regarding clinical parameters, in order to determine whether the two-hospital sample was representative of the entire region. In the two-hospital sample, 31.4% (n=79) of the patients had not been treated according to the guidelines. Positive margins were associated with LR (hazard ratio (HR)=4.790, 95% confidence interval (CI) 1.696-13.531). Breast-conserving surgery and deviation from the guidelines were independent predictors of LR (HR=7.842, 95% CI 2.126-28.926; HR=2.778, 95% CI 0.982-6.781, respectively). Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR=1.254, 95% CI 0.272-5.776 for time period 1992-1995 and HR=1.976, 95% CI 0.526-7.421 for time period 1996-1999). Clinical guidelines for the treatment of patients with DCIS have been developed and updated from existing literature and best evidence. Compliance with the guidelines was an independent predictor of disease-free survival. These findings support the application of guidelines in the treatment of DCIS.

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(A) Local recurrence-free survival in all patients who were treated according to the guidelines (guidelines+) and in all patients who were not treated according to the guidelines (guidelines−). (B) The 5-year local recurrence-free survival after BCS in patients who were treated according to the guidelines (guidelines+) and in patients who were not treated according to the guidelines (guidelines−).
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fig1: (A) Local recurrence-free survival in all patients who were treated according to the guidelines (guidelines+) and in all patients who were not treated according to the guidelines (guidelines−). (B) The 5-year local recurrence-free survival after BCS in patients who were treated according to the guidelines (guidelines+) and in patients who were not treated according to the guidelines (guidelines−).

Mentions: The median follow-up was 43 months (mean 49, range 10–120 months). Figure 1A shows that LR-free survival was better in patients who had been treated according to the guidelines than in patients who had been treated inappropriately (log rank 10.41, P=0.001). The 5-year LR-free survival in patients treated with BCS, was 91% in patients who had been treated according to the guidelines and 73% in patients who had not been treated so (log rank 4.77, P=0.029; Figure 1B).


Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ.

de Roos MA, de Bock GH, Baas PC, de Munck L, Wiggers T, de Vries J - Br. J. Cancer (2005)

(A) Local recurrence-free survival in all patients who were treated according to the guidelines (guidelines+) and in all patients who were not treated according to the guidelines (guidelines−). (B) The 5-year local recurrence-free survival after BCS in patients who were treated according to the guidelines (guidelines+) and in patients who were not treated according to the guidelines (guidelines−).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361497&req=5

fig1: (A) Local recurrence-free survival in all patients who were treated according to the guidelines (guidelines+) and in all patients who were not treated according to the guidelines (guidelines−). (B) The 5-year local recurrence-free survival after BCS in patients who were treated according to the guidelines (guidelines+) and in patients who were not treated according to the guidelines (guidelines−).
Mentions: The median follow-up was 43 months (mean 49, range 10–120 months). Figure 1A shows that LR-free survival was better in patients who had been treated according to the guidelines than in patients who had been treated inappropriately (log rank 10.41, P=0.001). The 5-year LR-free survival in patients treated with BCS, was 91% in patients who had been treated according to the guidelines and 73% in patients who had not been treated so (log rank 4.77, P=0.029; Figure 1B).

Bottom Line: Positive margins were associated with LR (hazard ratio (HR)=4.790, 95% confidence interval (CI) 1.696-13.531).Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR=1.254, 95% CI 0.272-5.776 for time period 1992-1995 and HR=1.976, 95% CI 0.526-7.421 for time period 1996-1999).Compliance with the guidelines was an independent predictor of disease-free survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands. mderoos@tiscali.nl

ABSTRACT
The aim was to study the effect of compliance with guidelines on local recurrence (LR)-free survival in patients treated for ductal carcinoma in situ (DCIS). From January 1992 to December 2003, 251 consecutive patients had been treated for DCIS in two hospitals in the North Netherlands. Every case in this two-hospital sample was reviewed in retrospect for its clinical and pathological parameters. It was determined whether treatment had been carried out according to clinical guidelines, and outcomes in follow-up were assessed. In addition, all patients treated for DCIS in this region (n=1389) were studied regarding clinical parameters, in order to determine whether the two-hospital sample was representative of the entire region. In the two-hospital sample, 31.4% (n=79) of the patients had not been treated according to the guidelines. Positive margins were associated with LR (hazard ratio (HR)=4.790, 95% confidence interval (CI) 1.696-13.531). Breast-conserving surgery and deviation from the guidelines were independent predictors of LR (HR=7.842, 95% CI 2.126-28.926; HR=2.778, 95% CI 0.982-6.781, respectively). Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR=1.254, 95% CI 0.272-5.776 for time period 1992-1995 and HR=1.976, 95% CI 0.526-7.421 for time period 1996-1999). Clinical guidelines for the treatment of patients with DCIS have been developed and updated from existing literature and best evidence. Compliance with the guidelines was an independent predictor of disease-free survival. These findings support the application of guidelines in the treatment of DCIS.

Show MeSH
Related in: MedlinePlus