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Risk of subsequentin situ and invasive breast cancer in human epidermal growth factor receptor 2-positive ductal carcinomain situ

2015; Elsevier BV; Volume: 26; Issue: 4 Linguagem: Inglês

10.1093/annonc/mdv013

1569-8041

Giuseppe Curigliano, Davide Disalvatore, Alessandro Esposito, Giancarlo Pruneri, Matteo Lazzeroni, Aliana Guerrieri‐Gonzaga, Alberto Luini, Roberto Orecchia, Aron Goldhirsch, Nicole Rotmensz, Bernardo Bonanni, Giuseppe Viale,

Cancer Treatment and Pharmacology

HER2 overexpression in primary ductal carcinomain situ (DCIS) was associated with a higher risk of in situ recurrence. No association with a higher risk of invasive breast cancer recurrence was observed. Our data have shown a clear benefit from radiotherapy in HER2-positive DCIS.BackgroundTo assess the prognostic role of human epidermal growth factor receptor 2 (HER2) overexpression in patients with ductal carcinomain situ (DCIS).Patients and methodsWe identified patients with HER2-positive DCIS among a population of 1667 cases, prospectively diagnosed and surgically treated at the European Institute of Oncology from 1996 to 2008. Rates of subsequent DCIS or invasive cancer in HER2-positive disease were estimated. We evaluated Cumulative Incidence ofIn Situ Breast Cancer Recurrence (isBCR), INvasive Breast Cancer Recurrence (IBCR) and any Breast Cancer Recurrence (BCR).isBCR, IBCR and BCR were defined as the time from surgery to breast cancer recurrence as first event (in situ, invasive or both, respectively) or last visit in case of no events.ResultsWe identified 560 (33.5%) patients with HER2-positive DCIS. The median follow-up was 7.6 years (interquartile range 5.9–9.5). We observed 422 events out of 1667 patients, with 141in situ recurrences, 201 invasive recurrences and 80 other events (64 second primaries and 16 deaths). The 10-yearisBCR proportions were 11.8% [95% confidence interval (CI) 9.0% to 15.4%] in the HER2-positive group and 8.8% (95% CI 6.9% to 11.0%) in the HER2-negative group (Gray test,P = 0.010). At multivariable analysis, the adjusted risk ofisBCR was higher in the HER2-positive group than in the HER2-negative group [hazard ratio (HR) HER2 positive versus negative: 1.59 (95% CI 1.06–2.39)]. We observed significant differences both in BCR and isBCR for patients treated by quadrantectomy without radiotherapy versus patients treated with radiotherapy [adjusted HR HER2 positive versus negative: 1.53 (95% CI 1.07–2.18) and adjusted HR HER2 positive versus negative: 2.18 (95% CI 2.18–3.69), respectively].ConclusionHER2 overexpression predicts an increased risk ofisBCR. Radiotherapy reduces local failure rates in HER2-positive DCIS.