Comment on: “Pathological features of 11,337 patients with primary ductal carcinoma in situ (DCIS) and subsequent events: results from the UK Sloane Project”
16 Feb 2021-British Journal of Cancer (Springer Science and Business Media LLC)-Vol. 124, Iss: 8, pp 1461-1462
About: This article is published in British Journal of Cancer.The article was published on 2021-02-16. It has received 2 citations till now. The article focuses on the topics: Ductal carcinoma in situ (DCIS).
Citations
More filters
2 citations
1 citations
References
More filters
TL;DR: Early and late recurrences are linked to different predictive factors and the modality of presentation of the recurrence together with the feasibility of a radical treatment are the best determinants for the prognosis.
Abstract: Hepatic resection is a well-accepted therapy for hepatocellular carcinoma (HCC), but many patients develop a cancer recurrence, which is the main cause of death in long-term evaluations.1–3 Prevention and therapy for recurrence could further improve the data of survival and support the value of surgery when compared to non surgical procedures such as percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA), or to liver transplantation (OLT).
The identification of the predictive factors of recurrence is the first step of this process. Different from other common gastrointestinal tumors, the pathologic features related to cancer presentation are not always related to the final results, expressed as overall survival (OS) and disease-free survival (DFS).4–7 This is not surprising; the recurrence of HCC includes some entities that are different for pathogenesis and clinical value, such as intrahepatic metastases of primary HCC or metachronous primary lesions.
Another factor to be considered is the time of presentation of recurrence; generally, shorter is the free interval time, poorer is the prognosis, but a clear line between early and late recurrences cannot be driven “a priori.”7
The aim of this study is: 1) to identify the factors influencing the risk and the type of recurrence and to verify if the type of presentation of the recurrence, including the morphology and the free interval time can identify groups of patients with a homogeneous behavior; and 2) to foresee the results that can be expected from an aggressive radical treatment of the different type of recurrence.
699 citations
TL;DR: Although I-IBTR increased the risk for breast cancer-related death, radiation therapy and tamoxifen reduced I- IBTR, and long-term prognosis remained excellent after breast-conserving surgery for DCIS.
Abstract: Results Of 490 IBTR events, 263 (53.7%) were invasive. Radiation reduced I-IBTR by 52% in the LRT group compared with LO (B-17, hazard ratio [HR] of risk of I-IBTR = 0.48, 95% confidence interval [CI] = 0.33 to 0.69, P < .001). LRT + TAM reduced I-IBTR by 32% compared with LRT + placebo (B-24, HR of risk of I-IBTR = 0.68, 95% CI = 0.49 to 0.95, P = .025). The 15-year cumulative incidence of I-IBTR was 19.4% for LO, 8.9% for LRT (B-17), 10.0% for LRT + placebo (B-24), and 8.5% for LRT + TAM. The 15-year cumulative incidence of all contralateral breast cancers was 10.3% for LO, 10.2% for LRT (B-17), 10.8% for LRT + placebo (B-24), and 7.3% for LRT + TAM. I-IBTR was associated with increased mortality risk (HR of death = 1.75, 95% CI = 1.45 to 2.96, P < .001), whereas recurrence of DCIS was not. Twenty-two of 39 deaths after I-IBTR were attributed to breast cancer. Among all patients (with or without I-IBTR), the 15-year cumulative incidence of breast cancer death was 3.1% for LO, 4.7% for LRT (B-17), 2.7% for LRT + placebo (B-24), and 2.3% for LRT + TAM. Conclusions Although I-IBTR increased the risk for breast cancer–related death, radiation therapy and tamoxifen reduced I-IBTR, and long-term prognosis remained excellent after breast-conserving surgery for DCIS.
664 citations
TL;DR: At 15 years, almost one in three nonirradiated women developed an LR after LE for DCIS, and RT reduced this risk by a factor of 2, although women who developed an invasive recurrence had worse survival.
Abstract: Purpose Adjuvant radiotherapy (RT) after a local excision (LE) for ductal carcinoma in situ (DCIS) aims at reduction of the incidence of a local recurrence (LR). We analyzed the long-term risk on developing LR and its impact on survival after local treatment for DCIS. Patients and Methods Between 1986 and 1996, 1,010 women with complete LE of DCIS less than 5 cm were randomly assigned to no further treatment (LE group, n = 503) or RT (LE+RT group, n = 507). The median follow-up time was 15.8 years. Results Radiotherapy reduced the risk of any LR by 48% (hazard ratio [HR], 0.52; 95% CI, 0.40 to 0.68; P < .001). The 15-year LR-free rate was 69% in the LE group, which was increased to 82% in the LE+RT group. The 15-year invasive LR-free rate was 84% in the LE group and 90% in the LE+RT group (HR, 0.61; 95% CI, 0.42 to 0.87). The differences in LR in both arms did not lead to differences in breast cancer–specific survival (BCSS; HR, 1.07; 95% CI, 0.60 to 1.91) or overall survival (OS; HR, 1.02; 95% CI, 0.71 t...
295 citations
TL;DR: The DCIS nomogram integrates 10 clinicopathologic variables to provide an individualized risk estimate of IBTR in a woman with DCIS treated with BCS and may assist in individual decision making regarding various treatment options and help avoid over- and undertreatment of noninvasive breast cancer.
Abstract: Purpose While the mortality associated with ductal carcinoma in situ (DCIS) is minimal, the risk of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) is relatively high. Radiation therapy (RT) and antiestrogen agents reduce the risk of IBTR and are considered standard treatment options after BCS. However, they have never been proven to improve survival, and in themselves carry rare but serious risks. Individualized estimation of IBTR risk would assist in decision making regarding the various treatment options for women with DCIS. Patients and Methods From 1991 to 2006, 1,868 consecutive patients treated with BCS for DCIS were identified. A multivariate Cox proportional hazards model was constructed using the 1,681 in whom data were complete. Ten clinical, pathologic, and treatment variables were built into a nomogram estimating probability of IBTR at 5 and 10 years after BCS. The model was validated for discrimination and calibration using bootstrap resampling. Results The D...
277 citations
TL;DR: In this paper, four randomized studies show that adjuvant radiotherapy (RT) lowers the risk of subsequent ipsilateral breast events after breast-conserving surgery (BCS) for ductal carcinoma in women.
Abstract: PURPOSE: Four randomized studies show that adjuvant radiotherapy (RT) lowers the risk of subsequent ipsilateral breast events (IBEs) after breast-conserving surgery (BCS) for ductal carcinoma in si
174 citations