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Does Progesterone Receptor Matter in the Risk of Recurrence for Patients With Ductal Carcinoma in Situ? WMJ 2018 Jun;117(2):62-67 PMID: 30048574

Pubmed ID

30048574

Abstract

BACKGROUND: Local recurrence is a major concern in patients diagnosed with ductal carcinoma in situ (DCIS). In invasive breast cancers, estrogen receptor (ER) (+)/progesterone receptor (PR) (-) subtype is considered more aggressive with poorer prognosis as compared to ER+/PR+ tumors. It is unclear whether this holds true in DCIS.

METHODS: Six hundred ninety-three patients diagnosed and treated for DCIS at Froedtert and Medical College of Wisconsin Cancer Center (February 2002 to March 2015) were studied to determine if the recurrence rates were significantly different between ER+/PR- and ER+/PR+ tumors. Recurrence was defined as either noninvasive or invasive ipsilateral, contralateral, or distant disease. Probabilities of recurrences were calculated using Kaplan-Meier estimator. Cox proportional hazards model was used to evaluate the effect of prognostic factors on DCIS recurrence.

RESULTS: Median follow-up was 5.2 years. The 5-year recurrence-free survival (RFS) was 91% (95% CI, 88.2-93.3) while estimated 7-year RFS was 86% (95% CI, 81.9-89.2). Seventy-five patients had a recurrence during their follow-up. Patients with ER-/PR- tumors (n = 118) had a significantly higher risk of recurrence (Hazard Ratio 3.7, 95% CI, 1.9-7.2, = 0.0001) whereas those with ER+/PR- subtype (n = 77) did not have a significant difference in recurrence risk (HR 1.75, 95% CI, 0.92-3.32, = 0.085) when compared to ER+/PR+ tumors (n = 482). No endocrine therapy for ER+ DCIS and lumpectomy alone were also significant predictors of recurrence ( = 0.0073 and = 0.005, respectively).

CONCLUSIONS: ER+/PR- subtype was not a significant predictor of recurrence in DCIS patients. This finding is in contrast to the recurrence risk seen in invasive breast cancers. Mastectomy and postlumpectomy radiation were associated with improved outcomes as was adjuvant endocrine therapy.

Author List

Chaudhary LN, Jawa Z, Hanif A, Szabo A, Kamaraju S, Cheng YC, Chitambar CR

Authors

Lubna N. Chaudhary MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Yee Chung Cheng MD Associate Professor in the Medicine department at Medical College of Wisconsin
Christopher R. Chitambar MD Professor in the Medicine department at Medical College of Wisconsin
Sailaja Kamaraju MD Associate Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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