title: Prognostic markers and long-term outcomes in ductal carcinoma in situ of the breast treated with excision alone.
abstract: BACKGROUND
  Increased use of breast cancer screening has led to an increase in the number of diagnosed cases of ductal carcinoma in situ (DCIS). However, there is no definite way to predict progression or recurrence of DCIS. We analyzed the significance of biological markers and tumor characteristics in predicting recurrence in a large series of DCIS patients with long-term follow-up treated with breast conservation surgery (BCS) alone.
  
  
  METHODS
  Clinical and pathological data were analyzed for 141 patients who underwent BCS for DCIS. All had negative surgical margins. Using local disease recurrence as an endpoint, we sought to determine the prognostic significance of several histopathological characteristics (tumor size, presence of necrosis, and subtype) and biological markers (estrogen receptor, progesterone receptor, and Her-2/neu.)
  
  
  RESULTS
  At a median follow-up of 122 months (maximum follow-up, 294 months), 60 recurrences occurred, with a median time to recurrence of 191 months. On multivariate analysis, Her-2 positivity (3+) was found to be significantly associated with reduced time to tumor recurrence (P = .028). Tumor size and higher grade were marginally statistically significant (P = .099, P = .070). Neither necrosis nor tumor pathological characteristics were found to be significantly related to time to disease recurrence.
  
  
  CONCLUSIONS
  Our results suggested that status of Her-2/neu, larger tumor size, and higher nuclear grade were significantly correlated with time to tumor recurrence in patients treated with BCS alone. Using logistical analyses, no significant correlation was found between tumor pathological characteristics and disease recurrence.
authors.affiliation: Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Holmes
authors.forename: Joshua
authors.initials: J
authors.lastname: Lloyd
authors.forename: Inna
authors.initials: I
authors.lastname: Chervoneva
authors.forename: Edward
authors.initials: E
authors.lastname: Pequinot
authors.forename: Dennis B
authors.initials: DB
authors.lastname: Cornfield
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Schwartz
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Allen
authors.forename: Juan P
authors.initials: JP
authors.lastname: Palazzo
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human