https://orcid.org/0000-0002-3847-8494
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Abstract
Purpose
Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS).
Materials and Methods
A retrospective cohort study of women diagnosed with DCISM from 1988 to 2015 who were identified in the Surveillance, Epidemiology and End Results database. Clinical variables and tumor characteristics were evaluated, and Cox proportional-hazards regression was performed. A nomogram was constructed from the multivariate logistic regression to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years.
Results
We identified 5438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988 and 2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery. The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65). Receiving chemotherapy was associated with a better BCSS (hazard ratio, HR=0.45, 95% confidence interval, 95% CI = 0.23–0.89), especially in patients with estrogen receptor (ER) negative, progesterone receptor (PR) negative (HR = 0.35, 95% CI = 0.13–0.97) and ER+PR-/ER-PR+ DCISM (HR = 0.07, 95% CI = 0.01–0.59).
Conclusion
Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up. Chemotherapy might benefit patients with ER-PR- and ER+PR-/ER-PR+ DCISM.
Acknowledgments
We would like to thank Xian-Ming Wang for providing resources for this study.
Abbreviations
DCISM, Ductal carcinoma in situ with microinvasion; DCIS, Ductal carcinoma in situ; BCSS, breast cancer-specific survival; AUC, area under the receiver operating characteristic curve; ROC, receiver operating characteristic; NCCN, National Comprehensive Cancer Network; AJCC, The American Joint Committee for Cancer; SEER, Surveillance, Epidemiology and End Results; HER2/neu, human epidermal growth factor receptor-2; ICD-O-3, International Classification of Disease for Oncology, Third Edition; ER, estrogen receptor; PR, progesterone receptor; NSABP, National Surgical Adjuvant Breast and Bowel Project; HR, hazard ratio; CI, confidence interval.
Data Sharing Statement
The datasets analyzed for this study can be found in the SEER database [http://www.seer.cancer.gov/ seerstat] Further inquiries can be directed to the corresponding author Yi-Zi Zheng.
Ethics Approval and Informed Consent
We obtained permission to access the SEER research data files using the reference number 15223-Nov2019. The data released by the SEER database do not require informed patient consent, and our study was approved by the Ethical Committee of Shenzhen Second People’s Hospital. The methods were performed in accordance with the principles stated in the Declaration of Helsinki.
Disclosure
The authors report no conflicts of interest in this work.