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Published on: December 5, 2017
Prognostic Implications of Calcification and Surgery Type by Estrogen Receptor and HER2 Status in Ductal Carcinoma In
Je Hyun Chin1, Jin Ah Lee1, Dooreh Kim1
1Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Purpose:
Ductal carcinoma in situ (DCIS) presents a challenge in risk stratification, raising concerns regarding both undertreatment and overtreatment. This study investigated the relationships among estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, clinicopathological features, and recurrence in DCIS, with a particular focus on the prognostic roles of calcification and surgical modality.
Methods:
A retrospective analysis was conducted in 365 patients who underwent surgery for DCIS at The Catholic University of Korea, Seoul St. Mary's Hospital between 1997 and 2020. Ipsilateral breast tumor recurrence (IBTR) and contralateral breast tumor recurrence (CBTR) were evaluated as the primary and secondary endpoints, respectively. Multivariable Cox models were implemented, incorporating radiotherapy, endocrine therapy, and margin status. 1:1 propensity score matching (PSM) was performed to adjust for selection bias between breast-conserving surgery and mastectomy.
Results:
ER-negative and HER2-positive DCIS were associated with older age, more frequent calcification, and higher nuclear grade (all p < 0.001). In the multivariable analysis for IBTR, surgical modality (mastectomy: hazard ratio [HR], 0.021; p = 0.014) and margin status (≥ 2 mm: HR, 0.192; p = 0.013) were the only independent predictors. Conversely, the presence of calcification was independently associated with more favorable outcomes for CBTR (HR, 0.103; p = 0.013). Subgroup analysis revealed that calcification was significantly associated with improved CBTR-free survival, particularly in the estrogen receptor-positive (ER+) cohort (p = 0.010). PSM analysis confirmed that mastectomy significantly reduced IBTR risk (p = 0.038) but was not significantly associated with CBTR risk (p = 0.246).
Conclusion:
Calcification and surgical modality demonstrated divergent prognostic implications for IBTR and CBTR according to molecular subtype. Although calcification is traditionally considered a high-risk feature prevalent in aggressive subtypes, its presence was associated with favorable contralateral events in ER+ DCIS. These findings emphasize the importance of integrating molecular markers with clinical features to support more personalized approaches to DCIS management.