The prognostic significance of multiple morphologic features and biologic markers in ductal carcinoma in situ of the breast
- 1 June 2004
- Vol. 100 (11), 2317-2327
- https://doi.org/10.1002/cncr.20260
Abstract
BACKGROUND A number of conventional histopathologic features have been associated with recurrence of ductal carcinoma in situ (DCIS) after surgery alone and are included in the Van Nuys Pathologic Classification and Prognostic Index. To the authors' knowledge, very little is known regarding the prognostic significance of the many biologic markers that have been studied in DCIS in the past decade. METHODS Clinical and pathologic data were analyzed from 151 patients who underwent wide local excision alone for DCIS that was diagnosed by mammography or as an incidental finding between 1982 and 2000. Using local disease recurrence as an endpoint, the authors sought to determine the prognostic significance of a large number of histopathologic parameters as well as biologic markers (estrogen receptor [ER], progesterone receptor [PR], p53, HER‐2/neu, Ki‐67, p21, and bcl‐2), as determined by immunohistochemical staining of contemporary or archival tissue. RESULTS With a median follow‐up of 65 months, 42 recurrences were reported to occur between 11 months and 97 months after definitive surgery. In a univariate analysis, tumor size, Van Nuys pathologic classification, and degree of necrosis demonstrated significant correlations with the rate of recurrence. Tumor size, necrosis, nuclear grade, and comedonecrosis were found to be associated significantly with the time to disease recurrence. None of the biologic markers demonstrated a significant association with the rate of recurrence or the time to disease recurrence. In a multivariate analysis, only large tumor size (Van Nuys 2 or 3) and higher degrees of necrosis (Van Nuys 2 or 3) were found to be associated significantly with both the rate of recurrence and the time to recurrence. No biologic marker showed a significant correlation with recurrence. Using Classification and Regression‐Tree Analysis and Tree‐Structured Survival Analysis, PR > 3.5% and bcl‐2 < 97.5% were associated with a higher recurrence rate in the subgroup of patients with small tumor size (Van Nuys size 1) and higher degrees of tumor necrosis (Van Nuys 2 or 3). CONCLUSIONS The current results confirmed the value of conventional histopathologic parameters, as outlined in the Van Nuys classification system, in predicting local recurrence of DCIS. Using traditional logistic analyses, no significant correlation was found between a variety of biologic markers and disease recurrence. Cancer 2004. © 2004 American Cancer Society.Keywords
This publication has 34 references indexed in Scilit:
- Pathological prognostic factors in breast cancerCritical Reviews in Oncology/Hematology, 1999
- The Influence of Margin Width on Local Control of Ductal Carcinoma in Situ of the BreastThe New England Journal of Medicine, 1999
- Loss of bcl-2 expression in ductal carcinoma in situ of the breast relates to poor histological differentiation and to expression of p53 and c-erbB-2 proteinsHistopathology, 1998
- p53 protein expression, cell proliferation and steroid hormone receptors in ductal and lobular in situ carcinomas of the breastEuropean Journal of Cancer, 1997
- Immunohistochemical evaluation of multiple biological markers in ductal carcinoma in situ of the breastEuropean Journal of Cancer, 1996
- The Bcl-2 Protein: a Prognostic Indicator Strongly Related to p53 Protein in Lymph Node-Negative Breast Cancer PatientsJNCI Journal of the National Cancer Institute, 1994
- p21 is a universal inhibitor of cyclin kinasesNature, 1993
- WAF1, a potential mediator of p53 tumor suppressionCell, 1993
- Bcl-2 is an inner mitochondrial membrane protein that blocks programmed cell deathNature, 1990
- Eight-Year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Lumpectomy with or without Irradiation in the Treatment of Breast CancerThe New England Journal of Medicine, 1989