Abstract P6-13-05: Clinical-pathological features and treatment modalities associated with disease recurrence in DCIS and micro-invasive carcinoma
Authors: Toss Angela , Berger Adam , Guiles Fran , Andrel Sendecki Jocelyn , Simone Nicole L , Anne Rani P , Avery Tiffany P , Jaslow Rebecca J , Palazzo Juan P , Lazar Melissa A , Tsangaris Theodore N , Cristofanilli Massimo 
Published: May 2015

Abstract
INTRODUCTION
The primary aim in the management of DCIS is the prevention of recurrence and contralateral tumor (CT). Previous studies reported that younger patients and African Americans (AAs) experience a higher risk of recurrence, second tumors and show worse overall survival. Nevertheless, risk factors for DCIS recurrence, treatments and outcome are still widely discussed. The aim of our analysis was to identify clinical-pathological features and treatment modalities associated with recurrence in DCIS and micro-invasive carcinoma (MIC).
METHODS
In the Thomas Jefferson University Tumor Registry, we identified 820 patients with DCIS and 61 with MIC treated between 2003 and 2013. Associations between recurrence and demographic factors, histopathological features and treatment were assessed.
RESULTS
The median age was 59 years with a racial distribution of 69.3% white, 19.5% AAs and 5.7% Asian. There was no significant difference in age at diagnosis by ethnicity and, 64.8% was ER/PR positive and 10.1% was HER2 positive. The associations of age and ethnicity with hormone status and HER2 status were not statistically significant. To date, 73 (8%) patients developed locoregional recurrence or CT, 50 (68.5%) of which were in situ lesions. Only one patient had MIC in primary lesion. There was no significant difference in age, while white women had higher recurrence rate than Asians and AAs (9% vs. 4%). ER/PR negative women were more likely to develop recurrence than ER/PR positive (16% vs. 8%). The hormonal status of primary DCIS and recurrences was concordant in 89% of cases. Moreover, 43.5% of recurrences were HER2 3+ and 23% were HER2 2+ (FISH unknown). Mastectomy was performed in 26.3% of patients and 73.1% had conservative surgery. Women who received conservative surgery were significantly older, while there were no significant ethnic differences. Among women who underwent conservative surgery, the 41.4% that received radiation therapy (RT) were significantly less likely to develop recurrence than the 53.2% that did not. However, there was no significant difference in recurrence between mastectomy and conservative surgery with RT. Among ER/PR positive patients, the 30% that received preventive hormone therapy was significantly less likely to develop recurrence than the 61.4% that did not.
CONCLUSION
Our study confirms that ER/PR negative DCIS is associated with significantly higher loco-regional recurrence and standard preventive modalities reduce the risk. White women appear to have a higher recurrence probably related to risk factors (e.g. obesity) while the distribution of histological subtypes of DCIS, age at diagnosis, MIC, and treatment modalities did not significantly differ among diverse ethnic groups. Interestingly, a high rate of HER2 positive recurrences has been reported in our sample, suggesting that HER2 may represent a potential biomarker for DCIS at high risk of recurrence and therefore HER-2 targeted therapeutic interventions (e.g. vaccines, trastuzumab) can contribute to prevent it. Further analyses are needed to confirm the correlation between age/ethnicity and DCIS outcome. Better define the subgroup at worse prognosis could help to identify biomarkers predictive of recurrence or second tumors.
Citation Format: Angela Toss, Adam Berger, Fran Guiles, Jocelyn Andrel Sendecki, Nicole L Simone, Rani P Anne, Tiffany P Avery, Rebecca J Jaslow, Juan P Palazzo, Melissa A Lazar, Theodore N Tsangaris, Massimo Cristofanilli. Clinical-pathological features and treatment modalities associated with disease recurrence in DCIS and micro-invasive carcinoma [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-13-05.