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Does Existence of Ductal Carcinoma In Situ Accompanying Invasive Ductal Carcinoma Lead to Different Clinicopathological Features and Clinical Outcome? Report of a Breast Cancer Registry

Document Type : Original Article(s)

Authors

1 Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Surgery, Division of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

3 Core Medical Trainee, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK

Abstract

Background: Ductal carcinoma in situ (DCIS) is widely recognized as the precursor of invasive ductal carcinoma (IDC). We aimed to compare clinicopathological characteristics and prognosis between IDC with and without coexisting DCIS stratified by biological subtypes to evaluate the clinical outcome of these two groups.
Method: Data from 5814 patients with IDC (32.4) and IDC/DCIS (67.6%), who underwent surgery from December 1993 through December 2019, were retrospectively assessed. We evaluated the prognosis of IDC with coexisting DCIS in different molecular subtypes.
Results: IDC/DCIS patients were younger (P < 0.001). They also presented with a low tumor grade and had less lymph node involvement compared with the pure IDC patients. Compared with the patients with IDC, luminal B subtype was more frequent in those with IDC/DCIS, with 19.4% versus 13.2 %; human epidermal growth factor receptor-2 enriched subtype was also more frequently observed, with 12.2 vs. 8.7%. The 5-year disease-free survival (DFS) was higher in the IDC/DCIS patients (P = 0.036). The survival outcomes significantly improved in the cases with a higher amount of DCIS. The presence of coexisting DCIS (P =0.038), tumor size (P < 0.001), lymph node status (P = 0.005), lymph vascular invasion (P = 0.02), and molecular subtypes (P < 0.001) were found to be DFS-associated independent prognostic factors.
Conclusion: DCIS along with IDC were associated with improved prognosis. The presence of DCIS may be a marker of lower aggressiveness, and could be noticed as a prognostic factor in future treatment algorithms.

Keywords

Full Text

How to cite this article:

Tahmasebi S, Shahin B, Ghoddusi Johari M, Akrami M, Zanguri V, Talei A, et al. Does existence of ductal carcinoma in situ accompanying invasive ductal carcinoma lead to different clinicopathological features and clinical outcome? Report of a breast cancer registry. Middle East J Cancer.  2022;13(3):472-82. doi: 10.30476/mejc.2022.86985.1384.

References
  1. Kim SY, Jung SH, Kim MS, Baek IP, Lee SH, Kim TM, et al. Genomic differences between pure ductal carcinoma in situ and synchronous ductal carcinoma in situ with invasive breast cancer. Oncotarget. 2015;6(10):7597-607. doi:10.18632/oncotarget.3162.
  2. Sgroi DC. Preinvasive breast cancer. Annu Rev Pathol. 2010;5:193-221. doi:10.1146/annurev.pathol.4.110807.092306.
  3. Lopez Gordo S, Blanch Falp J, Lopez-Gordo E, Just Roig E, Encinas Mendez J, Seco Calvo J. Influence of ductal carcinoma in situ on the outcome of invasive breast cancer. A prospective cohort study. Int J Surg. 2019;63:98-106. doi:10.1016/j.ijsu.2019.01.016.
  4. Goh CW, Wu J, Ding S, Lin C, Chen X, Huang O, et al. Invasive ductal carcinoma with coexisting ductal carcinoma in situ (IDC/DCIS) versus pure invasive ductal carcinoma (IDC): a comparison of clinicopathological characteristics, molecular subtypes, and clinical outcomes. J Cancer Res Clin Oncol. 2019;145(7):1877-86. doi: 10.1007/s00432-019-02930-2.
  5. Groen EJ, Elshof LE, Visser LL, Rutgers EJT, Winter-Warnars HAO, Lips EH, et al. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast. 2017;31:274-83. doi: 10.1016/j.breast.2016.09.001.
  6. Collins LC, Tamimi RM, Baer HJ, Connolly JL, Colditz GA, Schnitt SJ. Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses' Health Study. Cancer. 2005;103(9):1778-84. doi: 10.1002/cncr.20979.
  7. Leong AS, Sormunen RT, Vinyuvat S, Hamdani RW, Suthipintawong C. Biologic markers in ductal carcinoma in situ and concurrent infiltrating carcinoma. A comparison of eight contemporary grading systems. Am J Clin Pathol. 2001;115(5):709-18. doi: 10.1309/wbu9-22qn-c3na-2q12.
  8. Wärnberg F, Nordgren H, Bergkvist L, Holmberg L. Tumour markers in breast carcinoma correlate with grade rather than with invasiveness. Br J Cancer. 2001;85(6):869-74. doi: 10.1054/bjoc.2001.1995.
  9. Steinman S, Wang J, Bourne P, Yang Q, Tang P. Expression of cytokeratin markers, ER-alpha, PR, HER-2/neu, and EGFR in pure ductal carcinoma in situ (DCIS) and DCIS with co-existing invasive ductal carcinoma (IDC) of the breast. Ann Clin Lab Sci. 2007;37(2):127-34.
  10. Schorr MC, Pedrini JL, Savaris RF, Zettler CG. Are the pure in situ breast ductal carcinomas and those associated with invasive carcinoma the same? Appl Immunohistochem Mol Morphol. 2010;18(1):51-4. doi: 10.1097/PAI.0b013e3181acaded.
  11. Iakovlev VV, Arneson NC, Wong V, Wang C, Leung S, Iakovleva G, et al. Genomic differences between pure ductal carcinoma in situ of the breast and that associated with invasive disease: a calibrated aCGH study. Clin Cancer Res. 2008;14(14):4446-54. doi: 10.1158/1078-0432.CCR-07-4960.
  12. Castro NP, Osório CA, Torres C, Bastos EP, Mourão-Neto M, Soares FA, et al. Evidence that molecular changes in cells occur before morphological alterations during the progression of breast ductal carcinoma. Breast Cancer Res. 2008;10(5):R87. doi: 10.1186/bcr2157.
  13. Aubele M, Mattis A, Zitzelsberger H, Walch A, Kremer M, Welzl G, et al. Extensive ductal carcinoma In situ with small foci of invasive ductal carcinoma: evidence of genetic resemblance by CGH. Int J Cancer. 2000;85(1):82-6. doi: 10.1002/(sici)1097-0215(20000101)85:1<82::aid-ijc15>3.0.co;2-s.
  14. Wong H, Lau S, Yau T, Cheung P, Epstein RJ. Presence of an in situ component is associated with reduced biological aggressiveness of size-matched invasive breast cancer. Br J Cancer. 2010;102(9):1391-6. doi: 10.1038/sj.bjc.6605655.
  15. Jo BH, Chun YK. Heterogeneity of invasive ductal carcinoma: proposal for a hypothetical classification. J Korean Med Sci. 2006;21(3):460-8. doi: 10.3346/jkms.2006.21.3.460.
  16. Mylonas I, Makovitzky J, Jeschke U, Briese V, Friese K, Gerber B. Expression of Her2/neu, steroid receptors (ER and PR), Ki67 and p53 in invasive mammary ductal carcinoma associated with ductal carcinoma In Situ (DCIS) Versus invasive breast cancer alone. Anticancer Res. 2005;25(3A):1719-23.
  17. Papantoniou V, Sotiropoulou E, Valsamaki P, Tsaroucha A, Sotiropoulou M, Ptohis N, et al. Breast density, scintimammographic (99m)Tc(V)DMSA uptake, and calcitonin gene related peptide (CGRP) expression in mixed invasive ductal associated with extensive in situ ductal carcinoma (IDC + DCIS) and pure invasive ductal carcinoma (IDC): correlation with estrogen receptor (ER) status, proliferation index Ki-67, and histological grade. Breast Cancer. 2011;18(4):286-91. doi: 10.1007/s12282-009-0192-y.
  18. Carabias-Meseguer P, Zapardiel I, Cusidó-Gimferrer M, Godoy-Tundidor S, Tresserra-Casas F, Rodriguez-García I, et al. Influence of the in situ component in 389 infiltrating ductal breast carcinomas. Breast Cancer. 2013;20(3):213-7. doi: 10.1007/s12282-011-0330-1.
  19. Wu SG, Zhang WW, Sun JY, He ZY. Prognostic value of ductal carcinoma in situ component in invasive ductal carcinoma of the breast: a Surveillance, Epidemiology, and End Results database analysis. Cancer Manag Res. 2018;10:527-34. doi: 10.2147/CMAR.S154656.
  20. Talei A, Tahmasebi S, Akrami M, Zangouri V, Rezaianzadeh A, Arasteh P, et al. The Shiraz Breast Cancer Registry (SBCR): study design and primary reports. Per Med. 2018;15(6):471-9. doi: 10.2217/pme-2018-0047.
  21. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31(31):3997-4013. doi: 10.1200/JCO.2013.50.9984.
  22. Kole AJ, Park HS, Johnson SB, Kelly JR, Moran MS, Patel AA. Overall survival is improved when DCIS accompanies invasive breast cancer. Sci Rep. 2019;9(1):9934. doi: 10.1038/s41598-019-46309-2.
  23. Chagpar AB, McMasters KM, Sahoo S, Edwards MJ. Does ductal carcinoma in situ accompanying invasive carcinoma affect prognosis? Surgery. 2009;146(4):561-7; discussion 567-8. doi: 10.1016/j.surg.2009.06.039.
  24. Lee JS, Oh M, Ko S, Park MH, Oh SJ, Song JY, et al. IHC-breast cancer subtypes of invasive ductal carcinoma with predominant intraductal component as an insignificant prognostic factor: A register-based study from Korea. Cancer Treatment Communications. 2016;7:52-7. doi: 10.1016/j.ctrc.2016.03.008.
  25. Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB. Pathologic predictors of early local recurrence in Stage I and II breast cancer treated by primary radiation therapy. Cancer. 1984;53(5):1049-57. doi: 10.1002/1097-0142(19840301)53:5<1049::aid-cncr2820530506>3.0.co;2-o.
  26. Harris JR, Connolly JL, Schnitt SJ, Cady B, Love S, Osteen RT, et al. The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy. Ann Surg. 1985;201(2):164-9. doi: 10.1097/00000658-198502000-00005.
  27. Osteen RT, Connolly JL, Recht A, Silver B, Schnitt SJ, Harris JR. Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I or II breast cancer. Arch Surg. 1987;122(11):1248-52. doi: 10.1001/archsurg.1987.01400230034005.
  28. Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78(9):1921-8. doi: 10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-#.
  29. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74(6):1746-51. doi: 10.1002/1097-0142(19940915)74:6<1746::aid-cncr2820740617>3.0.co;2-y.
  30. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553-64. doi: 10.1016/j.ijrobp.2013.11.012.
  31. Cedolini C, Bertozzi S, Londero AP, Seriau L, Andretta M, Agakiza D, et al. Impact of the presence and quantity of ductal carcinoma in situ component on the outcome of invasive breast cancer. Int J Clin Exp Pathol. 2015;8(10):13304-13.
  32. Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31(19):2382-7. doi: 10.1200/JCO.2012.45.2615.
  33. Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379(2):111-21. doi: 10.1056/NEJMoa1804710.

 

Middle East Journal of Cancer
Volume 13, Issue 3 - Serial Number 51
July 2022
Pages 472-482
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