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Prognostic Score-Based Stratification Analysis Reveals Universal Benefits of Radiotherapy on Lowering the Risk of Ipsilateral Breast Event for Ductal Carcinoma In Situ Patients with Different Risk Levels

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We aimed to analyze the effects of radiotherapy (RT) on the incidence rate of ipsilateral breast event (IBE) in ductal carcinoma in situ (DCIS) patients with lumpectomy after being stratified by prognostic score.

Methods

We identified DCIS patients who received lumpectomy, from the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015. Cumulative incidence functions for competing risk were used to evaluate the effects of RT on IBE risk over time. Three multivariate regression models (weighted, non-weighted, and Fine–Gray) were applied to compare the IBE risk between the RT and non-RT groups after stratifying patients by prognostic score.

Results

Overall, 72,623 DCIS patients were identified from the SEER database and 49,206 (66.8%) patients received RT. During the follow-up period (ranging from 7 to 347 months), the cumulative probability of invasive and in situ IBE was significantly lower in the RT group than in the non-RT group (p < 0.001). After being stratified by prognostic score, the weighted IBE incidence rate increased as the risk level increased (p < 0.050). In multivariate regression models, RT lowered the IBE incidence rate by at least 30% in low-, moderate-, and high-risk DCIS (p < 0.010). In particular, the in situ and invasive IBE incidence rate decreased by over 50% in low-risk DCIS with RT (p < 0.001).

Conclusions

RT is associated with a lowered IBE incidence rate in DCIS patients, regardless of the assigned risk levels for patients. The significant reduction in the IBE incidence rate in low-risk DCIS patients also indicates the potential benefits for recommending RT to such a patient population in clinical practice.

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Acknowledgment

The authors would like to acknowledge Dr. Yun Wu for her assistance in study design.

Funding

This study was supported by the 1.3.5 Project for disciplines of excellence (ZYGD18012).

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Authors and Affiliations

  1. Department of Pathology, West China Hospital, Sichuan University, Chengdu, China

    Libo Yang MD, PhD, Mengjia Shen MD, PhD, Ting Lei MD, PhD, Tianjie Pu MD, PhD & Hong Bu MD, PhD

  2. Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China

    Libo Yang MD, PhD, Mengjia Shen MD, PhD, Ting Lei MD, PhD, Tianjie Pu MD, PhD & Hong Bu MD, PhD

  3. Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China

    Libo Yang MD, PhD, Mengjia Shen MD, PhD, Ting Lei MD, PhD, Tianjie Pu MD, PhD & Hong Bu MD, PhD

  4. Department of Life Sciences, Imperial College London, London, UK

    Dongli Lu PhD

  5. Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China

    Yutian Lai MD, PhD

  6. Department of Pathology, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China

    Qiuxiao Yu PhD

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  1. Libo Yang MD, PhD
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Yang, L., Lu, D., Lai, Y. et al. Prognostic Score-Based Stratification Analysis Reveals Universal Benefits of Radiotherapy on Lowering the Risk of Ipsilateral Breast Event for Ductal Carcinoma In Situ Patients with Different Risk Levels. Ann Surg Oncol 28, 975–984 (2021). https://doi.org/10.1245/s10434-020-09003-6

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  • DOI: https://doi.org/10.1245/s10434-020-09003-6

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