title: Impact of hormonal status on outcome of ductal carcinoma in situ treated with breast-conserving surgery plus radiotherapy: Long-term experience from two large-institutional series.
abstract: BACKGROUND
  Ductal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series.
  
  
  METHODS
  We collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy).
  
  
  RESULTS
  At a median follow up time of 10.8 years (range 3-25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate.
  
  
  CONCLUSIONS
  Our experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process.
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy. Electronic address: icro.meattini@unifi.it.
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.affiliation: Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bastiani
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Martella
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Francolini
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Lo Russo
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Paoletti
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Morena
authors.initials: M
authors.lastname: Doria
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Isacco
authors.initials: I
authors.lastname: Desideri
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Terziani
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: De Luca Cardillo
authors.affiliation: Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bendinelli
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Ciabatti
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Muntoni
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Galliano
authors.initials: G
authors.lastname: Tinacci
authors.affiliation: Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Nori
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Herd
authors.initials: H
authors.lastname: Smith
authors.affiliation: Struttura Complessa di Senologia Clinica, Cancer Research and Prevention Institute (ISPO), Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Brancato
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Galli
authors.affiliation: Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Luis Jose
authors.initials: LJ
authors.lastname: Sanchez
authors.affiliation: Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella
authors.affiliation: Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernini
authors.affiliation: Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Giulio Alberto
authors.initials: GA
authors.lastname: Carta
authors.affiliation: Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Breast Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000737:chemistry* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D011960:Receptors, Estrogen / Q000032:analysis*; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011960:Receptors, Estrogen
keywords: Breast cancer; Breast conserving surgery; Ductal carcinoma in situ; Hormonal status; Prognostic factors; Radiotherapy