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Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

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Abstract

While ductal carcinoma in situ (DCIS) is seldom life threatening, the management of DCIS remains a dilemma for patients and their physicians. Aggressive treatment reduces the risk of ipsilateral breast tumor recurrence (IBTR), but has never been proven to improve survival. There is interest in identifying the prognostic factors for determining low-risk DCIS patients, but a comprehensive review of high-quality evidence on tumor characteristics in predicting local recurrence has never been carried out. We examined the following tumor characteristics: biomarkers, comedonecrosis, focality, surgical margin, method of detection, tumor grade, and tumor size. For this systematic review we restricted the analyses to the results of subgroup analyses from randomized controlled trials (RCTs) and multivariate analyses from RCTs and observational studies. We identified 44 eligible articles. The pooled random-effects risk estimates for IBTR are comedonecrosis 1.71(95% CI, 1.36–2.16), focality 1.95(95% CI, 1.59–2.40), margin 2.25(95% CI, 1.77–2.86), method of detection 1.35(95% CI, 1.12–1.62), tumor grade 1.81(95% CI, 1.53–2.13), and tumor size 1.63(95% CI, 1.30–2.06). Limited evidence indicated that women whose DCIS is ER-negative, PR-negative, or HER2/neu receptor positive have an IBTR higher than those whose DCIS is ER-positive, PR-positive, and HER2/neu receptor negative. A variety of tumor characteristics are significant predictors for IBTR. These results are important for both clinicians and patients to interpret the risk of local recurrence and to decide on a course of treatment.

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Acknowledgments

This study was supported by the grant of the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, under Contract No. 290-02-10064-I. The authors of this report are responsible for its content. Statements in this article should not be construed as an endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Authors and Affiliations

  1. Department of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street S.E. MMC 729, Minneapolis, MN, 55455, Minnesota

    Shi-Yi Wang, Tatyana Shamliyan, Beth A. Virnig & Robert Kane

  2. Minnesota Evidence-based Practice Center, Minneapolis, MN, USA

    Tatyana Shamliyan & Robert Kane

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  1. Shi-Yi Wang
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  2. Tatyana Shamliyan
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Correspondence to Shi-Yi Wang.

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Wang, SY., Shamliyan, T., Virnig, B.A. et al. Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Breast Cancer Res Treat 127, 1–14 (2011). https://doi.org/10.1007/s10549-011-1387-4

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