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DCIS survival benefit from surgery varies by nuclear grade
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CHICAGO — Surgical management of ductal carcinoma in situ improved survival outcomes compared with non-operative management among patients with high-grade disease but not among those with low-grade disease, according to results of a SEER analysis presented at the ASCO Annual Meeting.
Although the current standard of care for ductal carcinoma in situ (DCIS) includes lumpectomy or mastectomy, surgical benefit was never fully established in this setting, according to study background.
“Our objective was to investigate whether there is a survival benefit offered by surgical treatment in patients with DCIS based on nuclear grade,” Yasuaki Sagara, MD, a research fellow in surgery in the department of surgery at Brigham and Women’s Hospital in Boston, said during his presentation.
Sagara and colleagues identified 57,222 eligible cases of DCIS that occurred between 1998 and 2011 using data from the SEER database.
Researchers divided patients into two groups: those who had surgery and those who were managed non-surgically.
The researchers assessed OS as well as breast cancer-specific survival in the cohort.
Overall, 98% of the patients underwent surgery, included 34,439 patients who underwent a lumpectomy and 16,334 who underwent a mastectomy. The remaining 2% of patients (n = 1,169) underwent nonsurgical management.
A greater proportion of patients in the non-surgery group were aged older than 60 years, were diagnosed after the year 2000, were black, had low-grade DCIS and did not undergo radiation therapy.
During a median follow-up of 6 years, 576 breast-cancer specific deaths occurred. A total of 3,652 deaths occurred from other causes.
Overall, the survival benefit for the surgery group significantly differed based on nuclear grade (P = .003).
The weighted 10-year breast cancer-specific survival was 98.5% for the surgery group compared with 93.5% in the non-surgery group (P < .001).
However, the breast cancer-specific survival rate in the nonsurgical arm decreased to 90.5% among high-grade patients. Surgical management significantly improved breast cancer-specific survival among high-grade patients (HR = 0.16; 95% CI, 0.11-0.23).
The weighted 10-year breast cancer-specific survival for low-grade DCIS was comparable in the surgical and nonsurgical arms (98.8% vs. 98.6%; HR = 0.88; 95% CI, 0.21-3.71).
For OS, the 10-year survival rate in the surgery group was 90%, regardless of nuclear grade. In the nonsurgical arm it was 87.9% among the low-grade patients and 79.1% among the high-grade patients.
Surgical management significantly improved OS among high-grade patients (HR = 0.4; 0.32-0.51) and intermediate-grade patients (HR = 0.7; 95% CI, 0.52-0.94) but not low-grade patients (HR = 0.86; 95% CI, 0.53-1.4).
“The survival benefit of breast surgery for low-grade DCIS was much smaller than that for intermediate- or high-grade DCIS,” Sagara said during the presentation. – by Anthony SanFilippo and Rob Volansky
Reference: Sagara, Y, et al. Abstract 1006 Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.
Disclosure: The researchers report no relevant financial disclosures.