Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies

E. Rakovitch, R. Gray, F. L. Baehner, R. Sutradhar, M. Crager, S. Gu, S. Nofech-Mozes, Sunil Badve, W. Hanna, L. L. Hughes, W. C. Wood, N. E. Davidson, L. Paszat, S. Shak, J. A. Sparano, L. J. Solin

Research output: Contribution to journalArticle

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Abstract

Purpose: Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Methods: Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. Results: The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. Conclusions: The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalBreast Cancer Research and Treatment
DOIs
StateAccepted/In press - Jan 31 2018

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Carcinoma, Intraductal, Noninfiltrating
Ontario
Cohort Studies
Recurrence
Segmental Mastectomy
Neoplasms
Proportional Hazards Models
Meta-Analysis
Decision Making

Keywords

  • DCIS
  • Ductal carcinoma in situ
  • Genomic
  • Local recurrence
  • Meta-analysis
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features : a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies. / Rakovitch, E.; Gray, R.; Baehner, F. L.; Sutradhar, R.; Crager, M.; Gu, S.; Nofech-Mozes, S.; Badve, Sunil; Hanna, W.; Hughes, L. L.; Wood, W. C.; Davidson, N. E.; Paszat, L.; Shak, S.; Sparano, J. A.; Solin, L. J.

In: Breast Cancer Research and Treatment, 31.01.2018, p. 1-11.

Research output: Contribution to journalArticle

Rakovitch, E, Gray, R, Baehner, FL, Sutradhar, R, Crager, M, Gu, S, Nofech-Mozes, S, Badve, S, Hanna, W, Hughes, LL, Wood, WC, Davidson, NE, Paszat, L, Shak, S, Sparano, JA & Solin, LJ 2018, 'Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies', Breast Cancer Research and Treatment, pp. 1-11. https://doi.org/10.1007/s10549-018-4693-2
Rakovitch, E. ; Gray, R. ; Baehner, F. L. ; Sutradhar, R. ; Crager, M. ; Gu, S. ; Nofech-Mozes, S. ; Badve, Sunil ; Hanna, W. ; Hughes, L. L. ; Wood, W. C. ; Davidson, N. E. ; Paszat, L. ; Shak, S. ; Sparano, J. A. ; Solin, L. J. / Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features : a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies. In: Breast Cancer Research and Treatment. 2018 ; pp. 1-11.
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abstract = "Purpose: Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Methods: Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. Results: The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8{\%}) or higher (> 15{\%}) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. Conclusions: The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.",
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T1 - Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features

T2 - a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies

AU - Rakovitch, E.

AU - Gray, R.

AU - Baehner, F. L.

AU - Sutradhar, R.

AU - Crager, M.

AU - Gu, S.

AU - Nofech-Mozes, S.

AU - Badve, Sunil

AU - Hanna, W.

AU - Hughes, L. L.

AU - Wood, W. C.

AU - Davidson, N. E.

AU - Paszat, L.

AU - Shak, S.

AU - Sparano, J. A.

AU - Solin, L. J.

PY - 2018/1/31

Y1 - 2018/1/31

N2 - Purpose: Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Methods: Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. Results: The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. Conclusions: The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

AB - Purpose: Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Methods: Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. Results: The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. Conclusions: The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

KW - DCIS

KW - Ductal carcinoma in situ

KW - Genomic

KW - Local recurrence

KW - Meta-analysis

KW - Prognosis

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