Cell biological factors in ductal carcinoma in situ (DCIS) of the breast-relationship to ipsilateral local recurrence and histopathological characteristics

All cases of ductal carcinoma in situ (DCIS) diagnosed from 1987 to 1991 in the Southern Health Care Region of Sweden, and operated upon with breast c onserving treatment (BCT) with (n = 66) or without (n = 121) postoperative radiation (RT) were clinically followed, morphologically re-evaluated and a nalysed for cell biological factors (immunohistochemical assays or DNA flow cytometry). Median age at diagnosis was 58 years (range 29-83 years) and m edian follow-up was 62 months. Oestrogen (ER)- and progesterone receptor (P R)-negativity, c-erbB-2 overexpression, low bcl-2 expression, p53 accumulat ion, DNA non-diploidy and high Ki67, were strongly associated with high gra de DCIS, and comedo-type necrosis. In contrast, significant associations to growth pattern (not diffuse versus diffuse) were seen only for c-erbB-2 an d PgR. There was also a strong relationship between the cell biological fac tors, and a summary cell biological index based on principal component anal ysis was introduced (CBI-7). In the group that had not received postoperati ve RT, 31 ipsilateral local recurrences occurred (13 invasive, 18 DCIS). Ip silateral recurrence-free interval (IL-RFI) was in univariate analyses sign ificantly, or almost significantly, shorter for patients showing p53 accumu lation, high Ki67 or low bcl-2, compared with patients with normal p53, low Ki67 and high bcl-2. The prognostic importance of the remaining cell biolo gical factors was less pronounced. On the other hand, the index CBI-7, was a strong predictor for recurrence. (C) 2001 Elsevier Science Ltd. All right s reserved.