Impact of Histopathological Factors, Patient History and Therapeutic Variables on Recurrence-free Survival after Ductal Carcinoma in Situ: 8-Year Follow-up and Questionnaire Survey

Abstract

Introduction: Ductal carcinoma in situ (DCIS) is a premalignant lesion of the glandular component of the breast and a precursor lesion of invasive breast cancer. In recent decades the incidence of DCIS has risen continuously, mainly because of more extensive screening and more advanced diagnostic procedures. There is an increasing need for evidence-based treatment guidelines which will protect patients as far as possible from recurrence or invasive cancer but also from overtreatment. This retrospective single-center clinical trial analyzed recurrence-free survival times, rates of invasive and non-invasive events, and the impact of patient history, histopathological variables and therapeutic factors on recurrence-free survival times. Material and Methods: A total of 200 patients who underwent surgery between 2000 and 2007 for pure DCIS were included in the study. As part of follow-up a questionnaire was sent to patients and their respective gynecologists. Results: In the follow-up period, 12.5 % (n = 25) of the 200 patients had recurrence (invasive or non-invasive event). Menopausal status, tumor grade and tumor size were significantly associated with recurrence. Low-grade DCIS was significantly more often hormone receptor-positive than high-grade DCIS. Patients who had postoperative radiotherapy significantly more often also received endocrine drug treatment. There was a significant association between younger patient age and drug treatment. The study found that in the investigated cohort, premenopausal women had a significantly shorter recurrence-free time compared to postmenopausal women. Conclusion: This paper summarizes the current literature on DCIS. There is a need for more prospective clinical trials to improve the prognosis of premenopausal women with large and hormone receptor-positive DCIS.

Zusammenfassung

Einleitung: Das duktale Carcinoma in situ der Brust (DCIS) ist eine prämaligne Neoplasie des Brustdrüsengewebes und unmittelbare Vorläuferläsion des invasiven Mammakarzinoms. Seine Inzidenz ist in den vergangenen Dekaden sprunghaft angestiegen. Folglich werden Richtlinien benötigt, die einerseits einen größtmöglichen Schutz vor DCIS-Rezidiven bzw. invasiven Karzinomen bieten, andererseits aber auch keine Übertherapie darstellen. Die vorliegende Arbeit untersucht neben der Dauer der rezidivfreien Zeit und der Ereignisrate (invasiv und noninvasiv) den Einfluss anamnestischer und histopathologischer Variablen, sowie therapeutischer Maßnahmen auf die rezidivfreie Zeit nach der Diagnose eines DCIS. Material und Methoden: Eingeschlossen wurden 200 Patientinnen, die in den Jahren 2000 bis 2007 an einem reinen DCIS operiert wurden. Zur Erfassung des Follow-ups wurde ein Fragebogen an die Patientinnen und den behandelnden Gynäkologen verschickt. Ergebnisse: Im Nachbeobachtungszeitraum kam es bei 12,5 % (n = 25) der 200 Patientinnen zu einem Rezidivereignis. Der Menopausenstatus, Malignitätsgrad und Tumorgröße waren signifikant mit der Rezidivrate assoziiert. Die niedrigmalignen DCIS waren ebenfalls signifikant häufiger kleiner und hormonrezeptorpositiv als hochmaligne. Patientinnen, die eine postoperative Radiatio durchführten, nahmen signifikant häufiger auch eine medikamentöse endokrine Therapie ein. Signifikant war ebenso der Zusammenhang zwischen jungem Patientinnenalter und der Einnahme einer medikamentösen Therapie. Die vorliegende Arbeit konnte für die untersuchte Kohorte nachweisen, dass prämenopausale gegenüber postmenopausalen Frauen eine signifikant kürzere rezidivfreie Zeit aufweisen. Schlussfolgerung: Dieser Artikel gibt einen aktuellen Überblick über die Literatur zum DCIS. Weitere prospektive Studien zur Untersuchung des Rezidivrisikos prämenopausaler Patientinnen, die an größeren und hormonrezeptorpositiven DCIS-Tumoren erkranken, sind notwendig, um Morbidität und Mortalität in dieser Patientinnengruppe zu senken.

Key words

hormone receptor-positive high-grade DCIS - radiation - age - tumor size

Schlüsselwörter

hormonrezeptorpositives höhergradiges DCIS - Radiatio - Alter - Tumorgröße

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