A PROGNOSTIC INDEX FOR DUCTAL CARCINOMA IN-SITU OF THE BREAST

BACKGROUND. There is controversy and confusion regarding therapy for p atients with ductal carcinoma in situ (DCIS) of the breast. The Van Nu ys Prognostic Index (VNPI) was developed to aid in the complex treatme nt selection process. METHODS. The VNPI combines three significant pre dictors of local recurrence: tumor size, margin width, and pathologic classification. Scores of 1 (best) to 3 (worst) were assigned for each of the 3 predictors and then totaled to give an overall VNPI score ra nging from 3 to 9. Three hundred thirty-three patients with pure DCIS treated with breast preservation (195 by excision only and 138 by exci sion plus radiation therapy) were studied with detection of local recu rrence as the end point. RESULTS. There was no statistical difference in the 8 year local recurrence free survival in patients with VNPI sco res of 3 or 4, regardless of whether or not radiation therapy was used (100% vs. 97%; P = not significant). Patients with VNPI scores of 5, 6, or 7 received a statistically significant 17% local recurrence free survival benefit when treated with radiation therapy (85% vs. 68%; P = 0.017). Patients with scores of 8 or 9, although showing the greates t relative benefit from radiation therapy, experienced local recurrenc e rates in excess of 60% at 8 years. CONCLUSIONS. DCIS patients with V NPI scores of 3 or 4 can be considered for treatment with excision onl y. Patients with intermediate scores (5, 6, or 7) show a 17% decrease in local recurrence rates with radiation therapy. Patients with VNPI s cores of 8 or 9 exhibit extremely high local recurrence rates, regardl ess of irradiation, and should be considered for mastectomy. (C) 1996 American Cancer Society.