Risk factors for recurrence and metastasis after breast-conserving therapyfor ductal carcinoma-in-situ: Analysis of European organization for research and treatment of cancer trial 10853

Purpose: In view of the increasing number of patients treated with breast-c onserving treatment (BCT) for ductal carcinoma-in-situ (CCIS), risk factors for recurrence and metastasis should be identified. Patients and Methods: Clinical and pathologic characteristics from patients with DCIS in the European Organization for Research and Treatment of Cance r trial 10853 (excision with or without radiotherapy) were related to the r isk of recurrence. Pathologic features were derived from a central review o f 863 of the 1,010 randomized cases (85%). The median follow-up was 5.4 yea rs. Results: Factors associated with an increased risk of local recurrence in t he multivariate analysis were young age (less than or equal to 40 years) (h azard ratio, 2.14; P =.02), symptomatic detection of DCIS (hazard ratio, 1. 80; P =.008), growth pattern (solid and cribriform) (hazard ratios, 2.67 an d 2.69, respectively; P =.012), involved margins (hazard ratio, 2.07; P =.0 008), and treatment by local excision alone (hazard ratio, 1.74; P =.009). The risk of invasive recurrence was not related to the histologic type of D CIS (P =.63), but the risk of distant metastasis was significantly higher i n poorly differentiated DCIS compared with well-differentiated DCIS (hazard ratio, 6.57; P =.01). Conclusion: Patients with poorly differentiated DCIS have a high risk of di stant metastasis after invasive local recurrence. Margin status is the most important factor in the success of BCT for DCIS; additionally, young age a nd symptomatic detection of CCIS have negative prognostic value. (C) 2001 b y American Society of Clinical Oncology.