title: Accompanying DCIS in breast cancer patients with invasive ductal carcinoma is predictive of improved local recurrence-free survival.
abstract: BACKGROUND
  Ductal carcinoma in situ (DCIS) often accompanies invasive ductal carcinoma (IDC). The presence of co-existing DCIS is postulated to present as a less aggressive phenotype than IDC alone.
  
  
  METHODS
  Patients diagnosed with hormone receptor-positive breast cancer receiving mastectomy were evaluated. Only patients without adjuvant radio- and chemotherapy were included to decrease treatment bias on local recurrence (LR).
  
  
  RESULTS
  Of 2239 breast cancer patients, 198 fulfilled the inclusion criteria. The overall LR rate was 11.6%. Tumor stage (p = 0.002), nodal status (pN2 vs. pN0, p = 0.023) and pure IDC compared with IDC-DCIS (p = 0.029) were multivariate independent factors for increased LR risk. Patients with IDC-DCIS were significantly younger (p < 0.001), had smaller tumors (p = 0.001), less lymph node involvement (p = 0.012). The LR rate was significantly increased in patients with pure IDC (p = 0.012). The time to distant metastases was decreased in patients with pure IDC compared with that observed in patients with IDC-DCIS (log rank = 0.030).
  
  
  CONCLUSIONS
  Invasive ductal carcinoma accompanied by DCIS is associated with lower LR. The prognostic value of co-existing DCIS in the adjuvant decision-making process may be considered a new independent prognostic marker. This finding needs further studies to evaluate its usefulness in premenopausal women.
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany. Electronic address: max.dieterich@uni-rostock.de.
authors.forename: M
authors.initials: M
authors.lastname: Dieterich
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hartwig
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stubert
authors.affiliation: Cancer Registry Rostock, Department of Radiotherapy, University of Rostock, Suedring 75, 18059 Rostock, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Klöcking
authors.affiliation: Institute for Biostatistics and Informatics in Medicine, University of Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kundt
authors.affiliation: Institute for Pathology, Hospital Suedstadt, Suedring 81, 18059 Rostock, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Stengel
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Reimer
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059 Rostock, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Gerber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies
keywords: Accompanying DCIS; Breast cancer; DCIS; Invasive carcinoma; Local recurrence; Prognosis