Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ.
We synthesized the evidence of the association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ of the breast. We identified five randomized controlled clinical trials and 64 observational studies that were published in English from January 1970 to January 2009. Younger women with clinically presented ductal carcinoma in situ had higher risk of ipsilateral recurrent cancer. African Americans had higher mortality and greater rates of advanced recurrent cancer. Women with larger tumor size, comedo necrosis, worse pathological grading, positive surgical margins, and at a higher risk category, using a composite prognostic index, had worse outcomes. Inconsistent evidence suggested that positive HER2 receptor and negative estrogen receptor status were associated with worse outcomes. Synthesis of evidence was hampered by low statistical power to detect significant differences in predictor categories and inconsistent adjustment practices across the studies. Future research should address composite prediction indices among race groups for all outcomes.
Shamliyan
Tatyana
T
Division of Health Policy and Management, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware St SE, Minneapolis, MN 55455, USA. shaml005@umn.edu
Wang
Shi-Yi
SY
Virnig
Beth A
BA
Tuttle
Todd M
TM
Kane
Robert L
RL
D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000737:chemistry / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000737:chemistry / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D012739:Gonadal Steroid Hormones / Q000009:adverse effects; D006801:Humans; D008327:Mammography; D008593:Menopause; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009376:Neoplasms, Hormone-Dependent / Q000737:chemistry / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012306:Risk; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D047368:Tumor Burden
D012739:Gonadal Steroid Hormones; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human