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Risk Factors for Recurrence and Metastasis After Breast-Conserving Therapy for Ductal Carcinoma-In-Situ: Analysis of European Organization for Research and Treatment of Cancer Trial 10853

From the Departments of Radiation Oncology and Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands; EORTC Data Center, Brussels, Belgium; Departments of Surgery and Pathology, Centre Henri Becquerel, Rouen, Department of Pathology, C.R.L.C. Val D’Aurelle, Montpellier, and Department of Pathology, Institut Bergonié, Bordeaux, France; Clinical Oncology Unit, Guy’s Hospital, London, United Kingdom; and Department of Pathology, Istituto Nazionale dei Tumori, Milano, Italy.

Address reprint requests to Johannes L. Peterse, MD, Department of Pathology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.

PURPOSE: In view of the increasing number of patients treated with breast-conserving treatment (BCT) for ductal carcinoma-in-situ (DCIS), risk factors for recurrence and metastasis should be identified.

PATIENTS AND METHODS: Clinical and pathologic characteristics from patients with DCIS in the European Organization for Research and Treatment of Cancer trial 10853 (excision with or without radiotherapy) were related to the risk of recurrence. Pathologic features were derived from a central review of 863 of the 1,010 randomized cases (85%). The median follow-up was 5.4 years.

RESULTS: Factors associated with an increased risk of local recurrence in the multivariate analysis were young age ( 40 years) (hazard ratio, 2.14; P = .02), symptomatic detection of DCIS (hazard ratio, 1.80; P = .008), growth pattern (solid and cribriform) (hazard ratios, 2.67 and 2.69, respectively; P = .012), involved margins (hazard ratio, 2.07; P = .0008), and treatment by local excision alone (hazard ratio, 1.74; P = .009). The risk of invasive recurrence was not related to the histologic type of DCIS (P = .63), but the risk of distant metastasis was significantly higher in poorly differentiated DCIS compared with well-differentiated DCIS (hazard ratio, 6.57; P = .01).

CONCLUSION: Patients with poorly differentiated DCIS have a high risk of distant metastasis after invasive local recurrence. Margin status is the most important factor in the success of BCT for DCIS; additionally, young age and symptomatic detection of DCIS have negative prognostic value.

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