TY - JOUR
T1 - Pathologic complete response of ductal carcinoma in situ to neoadjuvant systemic therapy in HER2-positive invasive breast cancer patients
T2 - a nationwide analysis
AU - Ploumen, R. A.W.
AU - Claassens, Eva L.
AU - Kooreman, Loes F.S.
AU - Keymeulen, Kristien
AU - van Kats, Maartje A.C.E.
AU - Gommers, Suzanne
AU - Siesling, Sabine
AU - van Nijnatten, Thiemo J.A.
AU - Smidt, Marjolein L.
N1 - Funding Information:
For this study, R. Ploumen received a grant from the Jules Coenegracht Senior Foundation (Maastricht, the Netherlands). The funder had no role in the conceptualization, data collection, analysis, interpretation, or writing.
Funding Information:
The authors gratefully thank the registration team of the Netherlands Comprehensive Cancer Organization for the collection of the data for the NCR. Furthermore, the authors gratefully thank the Dutch Nationwide Pathology Databank (PALGA) for providing the histopathologic data.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/9
Y1 - 2023/9
N2 - Purpose: Ductal carcinoma in situ (DCIS) is present in more than half of HER2-positive invasive breast cancer (IBC). Recent studies show that DCIS accompanying HER2-positive IBC can be completely eradicated by neoadjuvant systemic therapy (NST). Our aim was to determine the percentage of pathologic complete response of the DCIS component in a nationwide cohort and to assess associated clinicopathologic variables. Furthermore, the impact on surgical treatment after NST was investigated. Methods: Women diagnosed with HER2-positive IBC, treated with NST and surgery, between 2010 and 2020, were selected from the Netherlands Cancer Registry. Pre-NST biopsy and postoperative pathology reports were obtained from the Dutch Nationwide Pathology Databank and assessed for the presence of DCIS. Clinicopathologic factors associated with DCIS response were assessed using logistic regression analyses. Results: A DCIS component was present in the pre-NST biopsy in 1403 (25.1%) of 5598 included patients. Pathologic complete response of the DCIS component was achieved in 730 patients (52.0%). Complete response of DCIS occurred more frequently in case of complete response of IBC (63.4% versus 33.8%, p < 0.001). ER-negative IBC (OR 1.79; 95%CI 1.33–2.42) and more recent years of diagnosis (2014–2016 OR 1.60; 95%CI 1.17–2.19, 2017–2019 OR 1.76; 95%CI 1.34–2.34) were associated with DCIS response. Mastectomy rates were higher in IBC+DCIS compared to IBC (53.6% versus 41.0%, p < 0.001). Conclusion: Pathologic complete response of DCIS occurred in 52.0% of HER2-positive IBC patients and was associated with ER-negative IBC and more recent years of diagnosis. Future studies should investigate imaging evaluation of DCIS response to improve surgical decision making.
AB - Purpose: Ductal carcinoma in situ (DCIS) is present in more than half of HER2-positive invasive breast cancer (IBC). Recent studies show that DCIS accompanying HER2-positive IBC can be completely eradicated by neoadjuvant systemic therapy (NST). Our aim was to determine the percentage of pathologic complete response of the DCIS component in a nationwide cohort and to assess associated clinicopathologic variables. Furthermore, the impact on surgical treatment after NST was investigated. Methods: Women diagnosed with HER2-positive IBC, treated with NST and surgery, between 2010 and 2020, were selected from the Netherlands Cancer Registry. Pre-NST biopsy and postoperative pathology reports were obtained from the Dutch Nationwide Pathology Databank and assessed for the presence of DCIS. Clinicopathologic factors associated with DCIS response were assessed using logistic regression analyses. Results: A DCIS component was present in the pre-NST biopsy in 1403 (25.1%) of 5598 included patients. Pathologic complete response of the DCIS component was achieved in 730 patients (52.0%). Complete response of DCIS occurred more frequently in case of complete response of IBC (63.4% versus 33.8%, p < 0.001). ER-negative IBC (OR 1.79; 95%CI 1.33–2.42) and more recent years of diagnosis (2014–2016 OR 1.60; 95%CI 1.17–2.19, 2017–2019 OR 1.76; 95%CI 1.34–2.34) were associated with DCIS response. Mastectomy rates were higher in IBC+DCIS compared to IBC (53.6% versus 41.0%, p < 0.001). Conclusion: Pathologic complete response of DCIS occurred in 52.0% of HER2-positive IBC patients and was associated with ER-negative IBC and more recent years of diagnosis. Future studies should investigate imaging evaluation of DCIS response to improve surgical decision making.
U2 - 10.1007/s10549-023-07012-z
DO - 10.1007/s10549-023-07012-z
M3 - Article
SN - 0167-6806
VL - 201
SP - 227
EP - 235
JO - Breast cancer research and treatment
JF - Breast cancer research and treatment
ER -
