Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer

Gastric & Breast Cancer e-journal
DOI: 10.2122/gbc.2019.0279

Original Article

Comparison of two predictors of recurrence tools for ductal carcinoma in situ of breast cancer in our series.

Carolina de la Pinta1, Eva Fernández-Lizarbe1, Alfonso Muriel2, Belen Miez Pérez3, Ángel Montero4, Raúl Hernánz De Lucas1 , Mercedes Sánchez Martín1, Teresa Migueláñez Muñóz1, Sonsoles Sancho1.

Affiliation:
1Hospital Ramón y Cajal, Radiation Oncology, Madrid, Spain.
2Hospital Ramón y Cajal, Statistical Department, Madrid, Spain.
3Hospital Ramón y Cajal, Pathological Department, Madrid, Spain.
4HM Madrid, Radiation Oncology, Madrid, Spain.

E-mail: eva.lizarbe@gmail.com

Abstract
Objective
The aim of this study is to compare two published predictors’ tools of recurrence, the Memorial Sloan Kettering Cancer Center-nomogram (MSKCC-nomogram) and the Van Nuys Prognostic Index (VNPI), in predicting breast tumor recurrence in our series.
Patients and Methods
Data from 306 patients with ductal carcinoma in situ (DCIS) of the breast treated in our centre were collected. We calculated risk rate predictions with the two nomograms and compared the predictor power with the outcomes.
Results
Compare to VNPI, MSKCC nomogram overestimate 51.3% patients, and 21% of this developed local recurrence. 10.5% patients in MSKCC nomogram were underestimated, 6.25% of this had developed recurrence.
In recurrence subgroup (50/306 patients) we observed more patients in high-risk prediction in MSKCC nomogram than VNPI. Of 50 recurrences the MSKCC risk was overestimated in 33 patients (66%) and was underestimated in only 2 patients (4%).
In reclassified patients with MSKCC-nomogram the treatment would have been modified. Because of the underestimated risk of VNPI, 33 patients with recurrence would have been treated with more aggressive treatments.
IBTR was present in 38 patients, 20 of those had DCIS and 18 had invasive recurrence. VNPI classified DCIS recurrence as low risk 6 patients, 12p in intermediate risk and 2p in high risk with VNPI. 13 patients would have changed their risk and treatment indication if we had used MSKCC nomogram in IBTR. Kappa index showed poor correlation between these tools. Conclusions
We need optimal prediction tools to establish risk recurrence in DCIS. MSKCC nomogram is an excellent prediction tool. Combination two tools, MSKCC-nomogram and VNPI, increase prediction of recurrence in our DCIS patients.

(Citation: Gastric & Breast Cancer 2019; 14(1): 14-21)

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last update: 31 May 2019