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A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone.

Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, Tuck A, Sengupta S, Elavathil L, Jani PA, Bonin M, Chang MC, Robertson SJ, Slodkowska E, Fong C, Anderson JM, Jamshidian F, Miller DP, Cherbavaz DB, Shak S, Paszat L - Breast Cancer Res. Treat. (2015)

Bottom Line: Our objective was to confirm these results in a larger population-based cohort of individuals.Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR.Final evaluable population includes 718 cases, of whom 571 had negative margins.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, eileen.rakovitch@sunnybrook.ca.

ABSTRACT
Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

No MeSH data available.


Related in: MedlinePlus

Subgroup analyses of the 10-year LR risk by DCIS Score Group. The left side of the figure show the Kaplan–Meier estimates of the 10-year risk of any local recurrence (with 95 % CI) according to the DCIS Score pres-pecified risk groups. Blue boxes are estimates for the low DCIS Score risk group and are generally to the left of the overall LR rate of 19.2 %. Green boxes are estimates for the intermediate DCIS Score risk group. Red boxes are estimate for the high DCIS Score risk group and are generally to the right of the overall LR risk estimate. The box size is proportional to the number of patients. The right side of the figure shows the hazard ratios for LR risk, with 95 % CIs. The hazard ratios are calculated for a 50-point difference in the continuous DCIS Score
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Fig3: Subgroup analyses of the 10-year LR risk by DCIS Score Group. The left side of the figure show the Kaplan–Meier estimates of the 10-year risk of any local recurrence (with 95 % CI) according to the DCIS Score pres-pecified risk groups. Blue boxes are estimates for the low DCIS Score risk group and are generally to the left of the overall LR rate of 19.2 %. Green boxes are estimates for the intermediate DCIS Score risk group. Red boxes are estimate for the high DCIS Score risk group and are generally to the right of the overall LR risk estimate. The box size is proportional to the number of patients. The right side of the figure shows the hazard ratios for LR risk, with 95 % CIs. The hazard ratios are calculated for a 50-point difference in the continuous DCIS Score

Mentions: We evaluated the rates of LR by age at diagnosis and the presence of baseline pathological features of DCIS. With the exception of the presence of multifocality, individuals in the low DCIS Score group had lower 10-year rates of LR than those in the intermediate or high score groups (Fig. 3). Excluding individuals with multifocal DCIS, the 10-year rates of LR for the low, intermediate and high DCIS Score groups were 9.7, 27.1, and 27.0 % (log rank P < 0.001) (Supplemental Fig. 2, panel a); the corresponding 10-year rates of invasive LR were 5.6, 16.7, and 16.3 % (P = 0.02); and, the 10-year rates of DCIS LR were 4.3, 11.4, and 12.1 %, respectively (P = 0.02). (Supplemental Fig. 2, panels b, c).Fig. 3


A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone.

Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, Tuck A, Sengupta S, Elavathil L, Jani PA, Bonin M, Chang MC, Robertson SJ, Slodkowska E, Fong C, Anderson JM, Jamshidian F, Miller DP, Cherbavaz DB, Shak S, Paszat L - Breast Cancer Res. Treat. (2015)

Subgroup analyses of the 10-year LR risk by DCIS Score Group. The left side of the figure show the Kaplan–Meier estimates of the 10-year risk of any local recurrence (with 95 % CI) according to the DCIS Score pres-pecified risk groups. Blue boxes are estimates for the low DCIS Score risk group and are generally to the left of the overall LR rate of 19.2 %. Green boxes are estimates for the intermediate DCIS Score risk group. Red boxes are estimate for the high DCIS Score risk group and are generally to the right of the overall LR risk estimate. The box size is proportional to the number of patients. The right side of the figure shows the hazard ratios for LR risk, with 95 % CIs. The hazard ratios are calculated for a 50-point difference in the continuous DCIS Score
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4491104&req=5

Fig3: Subgroup analyses of the 10-year LR risk by DCIS Score Group. The left side of the figure show the Kaplan–Meier estimates of the 10-year risk of any local recurrence (with 95 % CI) according to the DCIS Score pres-pecified risk groups. Blue boxes are estimates for the low DCIS Score risk group and are generally to the left of the overall LR rate of 19.2 %. Green boxes are estimates for the intermediate DCIS Score risk group. Red boxes are estimate for the high DCIS Score risk group and are generally to the right of the overall LR risk estimate. The box size is proportional to the number of patients. The right side of the figure shows the hazard ratios for LR risk, with 95 % CIs. The hazard ratios are calculated for a 50-point difference in the continuous DCIS Score
Mentions: We evaluated the rates of LR by age at diagnosis and the presence of baseline pathological features of DCIS. With the exception of the presence of multifocality, individuals in the low DCIS Score group had lower 10-year rates of LR than those in the intermediate or high score groups (Fig. 3). Excluding individuals with multifocal DCIS, the 10-year rates of LR for the low, intermediate and high DCIS Score groups were 9.7, 27.1, and 27.0 % (log rank P < 0.001) (Supplemental Fig. 2, panel a); the corresponding 10-year rates of invasive LR were 5.6, 16.7, and 16.3 % (P = 0.02); and, the 10-year rates of DCIS LR were 4.3, 11.4, and 12.1 %, respectively (P = 0.02). (Supplemental Fig. 2, panels b, c).Fig. 3

Bottom Line: Our objective was to confirm these results in a larger population-based cohort of individuals.Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR.Final evaluable population includes 718 cases, of whom 571 had negative margins.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, eileen.rakovitch@sunnybrook.ca.

ABSTRACT
Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

No MeSH data available.


Related in: MedlinePlus