A Novel Biosignature Identifies Patients With DCIS With High Risk of Local Recurrence After Breast Conserving Surgery and Radiation Therapy.
Int J Radiat Oncol Biol Phys
; 115(1): 93-102, 2023 01 01.
Article
em En
| MEDLINE
| ID: mdl-36115740
ABSTRACT
PURPOSE:
There is an unmet need to identify women diagnosed with ductal carcinoma in situ (DCIS) with a low risk of in-breast recurrence (IBR) after breast conserving surgery (BCS), which could omit radiation therapy (RT), and also to identify those with elevated IBR risk remaining after BCS plus RT. We evaluated a novel biosignature for a residual risk subtype (RRt) to help identify patients with elevated IBR risk after BCS plus RT. METHODS AND MATERIALS Women with DCIS treated with BCS with or without RT at centers in the US, Australia, and Sweden (nâ¯=â¯926) were evaluated. Patients were classified into 3 biosignature risk groups using the decision score (DS) and the RRt category (1) Low Risk (DS ≤2.8 without RRt), (2) Elevated Risk (DS >2.8 without RRt), and (3) Residual Risk (DS >2.8 with RRt). Total and invasive IBR rates were assessed by risk group and treatment.RESULTS:
In patients at low risk, there was no significant difference in IBR rates with or without RT (total, Pâ¯=â¯.8; invasive IBR, Pâ¯=â¯.7), and there were low overall 10-year rates (total, 5.1%; invasive, 2.7%). In patients with elevated risk, IBR rates were decreased with RT (total hazard ratio [HR], 0.25; P < .001; invasive HR, 0.28; Pâ¯=â¯.005); 10-year rates were 20.6% versus 4.9% (total) and 10.9% versus 3.1% (invasive). In patients with residual risk, although IBR rates decreased with RT after BCS (total HR, 0.21; P < .001; invasive HR, 0.29; Pâ¯=â¯.028), IBR rates remained significantly higher after RT compared with patients with elevated risk (HR, 2.5; 95% CI, 1.2-5.4; Pâ¯=â¯.018), with 10-year rates of 42.1% versus 14.7% (total) and 18.3% versus 6.5% (invasive).CONCLUSIONS:
The novel biosignature identified patients with 3 distinct risk profiles Low Risk patients with a low recurrence risk with or without adjuvant RT, Elevated Risk patients with excellent outcomes after BCS plus RT, and Residual Risk patients with an elevated recurrence risk remaining after BCS plus RT, warranting potential intensified or alternative treatment approaches.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Mama
/
Carcinoma Intraductal não Infiltrante
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
Idioma:
En
Revista:
Int J Radiat Oncol Biol Phys
Ano de publicação:
2023
Tipo de documento:
Article