Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery
A majority of women with ductal carcinoma in situ (DCIS) receive breast-conserving surgery (BCS) but then face a risk of ipsilateral breast tumor recurrence (IBTR) which can be either recurrence of DCIS or invasive breast cancer. We developed a score to provide individualized information about IBTR risk to guide treatment decisions.
Data from 2762 patients treated with BCS for DCIS at centers within the National Comprehensive Cancer Network (NCCN) were used to identify statistically significant non-treatment-related predictors for 5-year IBTR. Factors most associated with IBTR were estrogen-receptor status of the DCIS, presence of comedo necrosis, and patient age at diagnosis. These three parameters were used to create a point-based risk score. Discrimination of this score was assessed in a separate DCIS population of 301 women (100 with IBTR and 200 without) from Kaiser Permanente Northern California (KPNC).
Using NCCN data, the 5-year likelihood of IBTR without adjuvant therapy was 9% (95% CI 5–12%), 23% (95% CI 13–32%), and 51% (95% CI 26–75%) in the low, intermediate, and high-risk groups, respectively. Addition of the risk score to a model including only treatment improved the C-statistic from 0.69 to 0.74 (improvement of 0.05). Cross-validation of the score resulted in a C-statistic of 0.76. The score had a c-statistic of 0.67 using the KPNC data, revealing that it discriminated well.
This simple, no-cost risk score may be used by patients and physicians to facilitate preference-based decision-making about DCIS management informed by a more accurate understanding of risks.
KeywordsDuctal carcinoma in situ Recurrence risk Risk score
We would like to thank Luana Acton for her help with the Kaiser patient database, Jane C. Weeks for her guidance with the NCCN dataset, and Deborah Schrag for her time and suggestions.
This work was supported by Contract No. HHSA29020050016I from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, as part of the Developing Evidence to Inform Decisions About Effectiveness program. The views expressed in this article are those of the authors, and no official endorsement by AHRQ or the US Department of Health and Human Services is intended or should be inferred. This work was also supported by Grant No. CA89393 from the National Cancer Institute to the Dana-Farber Cancer Institute, Grant No. R01 CA 81302 to Kaiser Permanente Northern California, and Grant no. 2U19CA079689 to Group Health Cooperative (Habel, Project Leader).
Compliance with ethical standards
Conflict of interest
None of the authors have any conflict of interest related to the subject matter presented. Author Wong is currently employed by Janssen Scientific Affairs.
This article is a retrospective review of patient data, and has received IRB approval for data collection from each of the institutions providing patient data and from DFCI/HCC IRB for the analysis. This article does not contain any studies with animals or human participants performed by any of the authors.
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