@article{a9c12313cfca494bab824d062811e8b7,
title = "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",
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.",
keywords = "DCIS, Ductal carcinoma in situ, Genomic, Local recurrence, Meta-analysis, Prognosis",
author = "E. Rakovitch and R. Gray and Baehner, {F. L.} and R. Sutradhar and M. Crager and S. Gu and S. Nofech-Mozes and Badve, {S. S.} and W. Hanna and Hughes, {L. L.} and Wood, {W. C.} and Davidson, {N. E.} and L. Paszat and S. Shak and Sparano, {J. A.} and Solin, {L. J.}",
note = "Funding Information: Acknowledgement This study is a joint collaboration by the ECOG-ACRIN Cancer Research Group (Peter J. O{\textquoteright}Dwyer, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs), Genomic Health, Inc., and the Institute for Clinical Evaluative Sciences and is supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: CA180820, CA180794, CA180864, CA180795, CA189859, CA180828, CA180844 and the Canadian Cancer Society Research Institute (Grant Number 18491). Dr. Rako-vitch is the LC Campbell Chair for Breast Cancer Research. We would like to acknowledge the contributions of pathologists Dr. A. Tuck, Dr. S. Robertson, Dr. S. Sengupta, Dr. M. Bonin, Dr. M.C. Chang, Dr. L. Elavathil and Dr. E. Slodkowska in the pathology review of the Ontario cohort. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, nor does mention of trade names, commercial products or organizations imply endorsement by the US government. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. These datasets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences (ICES). Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements Funding Information: Conflicts of interest Dr. E. Rakovitch has received research grant funding from Genomic Health Inc. FL Baehner has received remuneration and owns stock in Genomic Health Inc. M Crager owns stock in Genomic Health Inc. S Badve has received a speaker honorarium from Genomic Health Inc., Genentech, and MSD. S Shak has received remuneration and owns stock in Genomic Health Inc. LJ Solin is an advisory board member of Genomic Health Inc., with no compensation received. The other authors have no conflict of interest to declare.",
year = "2018",
month = jun,
day = "1",
doi = "10.1007/s10549-018-4693-2",
language = "English (US)",
volume = "169",
pages = "359--369",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",
number = "2",
}